妊娠34週の卵管捻転に対する腹腔鏡手術〜腹壁に描いた病巣と妊娠子宮の輪郭図が適切なトロッカー配置に有用であった症例〜

抄録

　Drawing outlines of the lesion and the uterus on the abdominal wall were helpful in appropriately placing trocars and completing laparoscopic salpingectomy for fallopian tube torsion at 34 weeks of gestation.

Case: A 34-year-old primipara underwent an exploratory laparoscopy for right lower abdominal pain. We drew an outline of the lesion and the uterus on the patient's abdominal wall using ultrasonography. The marking showed that the operative field was limited to a narrow area in the right-upper abdomen. After comparison of the distance from the upper edge of the operative field to the drawn lesion with the length of the forceps, laparoscopic surgery was deemed to be feasible.

　The first trocar was placed at the point where a tangential line of the outer uterine margin passing through the lesion intersected with the midline of the abdominal wall. The second trocar was placed under the rib arch on the right anterior axillary line, and the third trocar was placed between them. A 10-mm, 30° viewing angle laparoscope was used as the camera to avoid interference with the forceps. The twisted and necrotic right fallopian tube was removed with a walnut-sized para-ovarian cyst. The postoperative course was uneventful, and the patient delivered a healthy baby at full term.

Conclusion: Drawing the lesion and the outline of the uterus on the abdominal wall was helpful in determining the most appropriate trocar position during laparoscopy in the third trimester of pregnancy.