子宮頸部円錐切除後のマニピュレーター挿入困難な頸管狭窄例に対する全腹腔鏡下子宮全摘術の検討

抄録

　A uterine manipulator is a useful device that facilitates safe total laparoscopic hysterectomy (TLH). However, cervical stenosis may occasionally occur after cervical conization, particularly in postmenopausal women or in women who undergo deep cervical resection. The routine use of a uterine manipulator during TLH becomes impossible in such cases. We report safe and effective TLH for post-conization cervical stenosis; we have focused on the surgical technique based on intraoperative videos. Of the 27 patients who underwent TLH after cervical conization between November 2016 and June 2018 at our hospital, 11 patients developed post-conization cervical stenosis. Based on outpatient medical records, cervical stenosis was defined as difficulty with uterine probe insertion. In this study, routine insertion of a uterine manipulator was not possible in patients with cervical stenosis; however, laparoscopy guided uterine manipulator insertion was successful in 70% of patients. Despite the inability to insert the manipulator, we could successfully perform safe TLH using an additional port to pull the uterus.