ロボット支援下子宮全摘術後に卵巣捻転を生じた１例

抄録

Background: Ovarian torsion may rarely occur after ovary-sparing total laparoscopic hysterectomy. In recent years, the number of cases of robot-assisted total hysterectomy has gradually increased, but there have been no reported cases of ovarian torsion after this procedure. Here, we report a case of right ovarian torsion after robot-assisted total hysterectomy.

Case: A 46-year-old woman with multiple myoma uteri underwent robot-assisted total hysterectomy. One year later, she developed right lower abdominal pain, then visited our hospital, where we suspected right ovarian torsion. Since her pain did not diminish, she underwent laparoscopic surgery. Her right ovary was enlarged to 6 cm in diameter, with ovarian torsion, and laparoscopic right oophorectomy was performed.

Conclusion: Postoperative ovarian torsion is more frequent with total laparoscopic hysterectomy than with open or vaginal hysterectomy. Reasons for this include increased ovarian mobility due to excessive incision of the broad membrane with the lateral approach and fewer postoperative adhesions. To prevent ovarian torsion, it is important to use a posterior approach and to perform ovarian fixation if needed. In addition, it is recommended to consider the possibility of ovarian torsion when patients have abdominal pain after hysterectomy.