脳室腹腔シャント留置患者に対し全腹腔鏡下子宮全摘術を安全に施行し得た１例

抄録

　Ventriculoperitoneal shunt (VPS) implantation is a surgical treatment for hydrocephalus. Laparoscopic surgery for VPS implantation is associated with the risk of shunt dysfunction due to increased intra-abdominal pressure, intracranial pressure, and infection. Therefore, patients with VPS implantation should be managed carefully during the perioperative period.

　A 43-year-old woman presented with hypermenorrhea. She had undergone VPS implantation for hydrocephalus due to meningitis when she was 1 month old. Further investigation with computed tomography (CT) and ultrasonography led to a diagnosis of adenomyosis. The patient preferred hysterectomy over medical treatment. Thus, in collaboration with neurosurgeons, we performed total laparoscopic hysterectomy.

　To avoid damaging the VPS, we examined the VPS route by CT. Because the shunt did not have a backflow prevention valve, we clamped the bilateral shunts before CO₂ insufflation and placed the patient in the Trendelenburg position. Finally, we cut off the tips of the shunt to release the clamp and confirmed the presence of cerebral fluid from the shunt tips. The operation was performed without complications.

　There is no consensus regarding the conditions of laparoscopic surgery for patients with VPS, for example, CO₂ insufflation pressure, clamping, and patient body position. Because most recent VPSs contain shunt valves, it is important to consider the operative procedures for each case in cooperation with neurosurgeons.