生体腎移植後に腹腔鏡下準広汎子宮全摘出術を施行した１例

抄録

　A 47-year-old woman underwent living renal transplantation at the age of 41 and had been taking oral immunosuppressive drugs. She was diagnosed with intramural myoma and suspected of lobular endocervical glandular hyperplasia. Laparoscopic modified radical hysterectomy was planned. Before the operation, everolimus was changed to mycophenolate mofetil because of wound healing complications. Location of the transplanted pelvic kidney and ureter must be considered when performing laparoscopic hysterectomy in patients who had previously undergone renal transplantation. Computed tomography was performed to check the same for selection of the site for trocar insertion. When there is enough distance from transplanted ureter to internal iliac artery, laparoscopic hysterectomy can be performed safely. Considering the adhesion and hemorrhagic tendency of the anterior vesico-uterine ligament on the transplanted kidney side, hemostasis of the vaginal wall may be difficult. It may reduce the amount of bleeding when isolating the uterine artery. In this case, the renal artery of the transplanted kidney was anastomosed to the right internal iliac artery. It was considered safer to isolate and cut the right uterine artery on the peripheral side, away from the internal iliac artery. Although laparoscopic modified radical hysterectomy can be performed after renal transplantation, it is necessary to recognize that it may be difficult to cut off the anterior layer of the vesico-uterine ligament of the transplanted renal side.