細径腹腔鏡システム-バスタブ法にて内容物を漏出、飛散させる事なく摘出し得えた皮様嚢腫、parasitic myoma合併の一例

抄録

　We have previously reported the usefulness of a needle laparoscopic surgery system that involves insertion of a port through the Douglas' pouch and use of an EndoPouch to facilitate cystectomy without leakage of the ovarian cyst contents.

　A 32-year-old woman (G0P0) with an unremarkable medical and surgical history visited a clinic for evaluation of lower abdominal pain and was referred to our hospital for management of a left ovarian cyst. Transvaginal ultrasonography and pelvic magnetic resonance imaging revealed a left ovarian cyst (6 cm in diameter) and several subserosal fibroids (up to 3 cm in size). A 5-mm optical trocar was inserted into the umbilical region, 3-mm ports into the left and right lower abdomen, and a 12-mm port into the Douglas' pouch. An EndoPouch was introduced via the port inserted into the Douglas' pouch, and the left ovarian cyst was carefully placed in it; we performed successful cystectomy without leakage of the cystic contents. The cyst wall, tumor contents, and a fibroid were placed into the EndoPouch and cautiously extracted from the Douglas' pouch.

　Histopathological evaluation confirmed diagnosis of a mature cystic teratoma and significantly degenerated leiomyoma. In this patient who denied a history of myomectomy and presented with multiple subserosal fibroids, we concluded that one of the subserosal fibroids was dislodged from the uterus and was implanted into the retroperitoneum via the bloodstream. This case report highlights that needle laparoscopic surgery was an effective and minimally invasive method for successful intra-abdominal tumor removal.