後腟円蓋部トロカー留置により子宮牽引を行った腹腔鏡下子宮体癌手術の経験〜単一施設での22例の検討〜

抄録

Objective: We describe our initial experience with laparoscopic surgery for endometrial cancer using trocar insertion into the posterior vaginal fornix.

Methods: This retrospective study included 22 women with clinical stage IA endometrial cancer, who underwent laparoscopic surgery at our hospital between April 2018 and December 2020. We avoid the use of uterine manipulators at our hospital to minimize the risk of cancer cell dissemination and prefer natural orifice transluminal endoscopic surgery, which involves insertion of trocars into the posterior vaginal fornix to achieve uterine traction. We recorded the operation time, estimated blood loss, number of extirpated lymph nodes, surgery-induced complications, and safety of trocar insertion into the posterior vaginal fornix.

Results: All 22 women underwent bilateral salpingo-oophorectomy; pelvic lymphadenectomy was performed in 16 women. The median operation time was 218.5 (range 166-299) min in women who underwent additional pelvic lymphadenectomy and 109 (range 93-153) min in women who did not undergo pelvic lymphadenectomy. The median estimated blood loss was 50 (range 5-280) mL in operations with additional pelvic lymphadenectomy and 12.5 (range 5-27) mL in operations without pelvic lymphadenectomy. The median number of lymph nodes resected in the pelvic lymphadenectomy group was 23.5. All procedures were successfully performed without additional transabdominal trocar insertion. No intraoperative complications occurred, and no patient required conversion to laparotomy.

Conclusion: Laparoscopic surgery for endometrial cancer with trocar insertion into the posterior vaginal fornix was safe with regard to short-term outcomes.