BMI 45の高度肥満と気管を圧排する巨大甲状腺腫瘍を合併した子宮体癌に対して腹腔鏡下手術を施行した一例

抄録

　Laparoscopic hysterectomy is widely performed in obese patients in Japan; however few studies have reported on laparoscopic surgery in patients with severe obesity (body mass index [BMI] > 35 kg/m²). Here, we share our experience of performing laparoscopic hysterectomy for endometrial carcinoma in a patient with severe obesity and a giant thyroid tumor. Our patient was a 69-year-old woman (height 151 cm, weight 104 kg [BMI 45 kg/m²]) with a history of hypertension, diabetes mellitus, and hyperlipidemia and appendectomy, who presented with endometrial cancer and a thyroid tumor. Endometrial biopsy findings revealed carcinosarcoma and magnetic resonance imaging showed an endometrial tumor without myometrial or cervical stromal invasion, with uterine adnexal metastasis. Computed tomography revealed a giant thyroid tumor in the left lobe (82 mm) with bronchial compression, but no lymphadenopathy. Fine needle aspiration cytology revealed a benign thyroid tumor. Because of severe obesity and a giant thyroid tumor, we performed laparoscopic hysterectomy and concomitant thyroidectomy. We initially performed thyroidectomy under general anesthesia using tracheal intubation (tube diameter: 6 mm) in the supine position, followed by laparoscopic hysterectomy using tracheal intubation (tube diameter: 7 mm) with the patient placed in the Trendelenburg position. After the surgery, the patient was admitted in the intensive care unit for only one day, and after an uneventful course, was discharged on day 5 postoperatively. Adjuvant chemotherapy for endometrial cancer was initiated at 1 month postoperatively. This report highlights that laparoscopic hysterectomy can reduce perioperative complications and enable prompt initiation of adjuvant chemotherapy in patients with severe obesity. Thus, obesity and comorbidities are not contraindications for laparoscopic surgery.