ロボット支援下腹腔鏡下子宮全摘術の創部を使用し腹腔鏡下に追加手術を施行した子宮内膜間質肉腫の１例

抄録

　Endometrial stromal sarcoma, a rare disease, accounts for approximately 0.2％ of all types of uterine malignancies. The disease may be difficult to differentiate from the benign one using preoperative imaging and histological diagnosis. We report a case of a patient who underwent robot-assisted surgery for uterine adenomyosis and was diagnosed with low-grade endometrial stromal sarcoma. She underwent additional laparoscopic surgery using the initial surgical wound. A 45-year-old gravida 4, para 2 was referred because of excessive menstruation caused by uterine adenomyosis. Ultrasound and magnetic resonance imaging revealed uterine adenomyosis and a 5-cm right endometrioid ovarian cyst. Cytology did not reveal any suspicious findings for malignant disease. Hormone therapy was initiated, but bleeding and anemia were observed. Hence, robotic surgery was performed. Robot-assisted laparoscopic hysterectomy, right adnexectomy, and left tubectomy were performed using the da Vinci Xi system. The patient was discharged without any postoperative problems.

　Pathological examination revealed low-grade endometrial stromal sarcoma, FIGO pT1a, NX, M0, stage IA. Based on the pathological diagnosis, laparoscopic removal of the left ovary was decided. The same wound as the initial surgery was used for the operation. No malignant findings were observed in the removed ovaries. When additional laparoscopic surgery was required after robot-assisted surgery, laparoscopic surgery using the previous wound was thought to be a safe option.