腹腔鏡下子宮全摘出術時に整形外科器具を使用して細切した石灰化筋腫の一例

抄録

　Calcification of uterine myoma is not rare. However, due to the hardness of calcified myomas, sometimes it is difficult to extract the myoma from the pelvic cavity during a total laparoscopic hysterectomy (TLH). We present a case of a patient with a large uterine calcified myoma who underwent TLH. A 52-year-old virgin woman was diagnosed with multiple large uterine myomas with a maximal size of 120 mm by magnetic resonance imaging. An abdominal X-ray examination identified one of the myomas as calcified. The patient underwent TLH. Even though we tried to extract the uterus and myomas by in-bag morcellation, the calcified myoma was not morcellated using a power morcellator. Then, after adding a small 40 mm incision to the main port site, orthopedic instruments were used to morcellate the calcified myoma safely. Uterine weight was 1163 g, operative time was 387 minutes and intraoperative blood loss was 325 ml.

　If the calcified uterine myoma is too hard to be morcellated using gynecological surgical instruments, it is thought to be possible to morcellate the specimen using orthopedic instruments with great care.