腹腔鏡下卵巣成熟嚢胞性奇形腫核出術の手技と妊孕性に関する若手医師対象の意識調査

抄録

Objective: In Japan, total laparoscopic cystectomy for ovarian mature cystic teratoma (TLC-MCT) is commonly performed by early-career laparoscopists. However, some experienced gynecological surgeons view TLC-MCT as a technically demanding surgery that requires surgical proficiency. Additionally, postoperative ovarian reserve directly affects fertility potential in assisted reproductive technology. This poses a contradiction: inexperienced laparoscopists perform proficiency-dependent procedures with substantial impacts on fertility. While developing expert skills from the outset is unrealistic, supervising and junior gynecologists should focus on optimizing the learning curve. Thus, we surveyed early-career gynecologists on their awareness of surgical techniques and fertility considerations in TLC-MCT.

Methods: A questionnaire about TLC-MCT was distributed to early-career gynecologists who are or have been affiliated with our program.

Results: Thirty-one doctors (84%) responded. Among them, 97% agreed that TLC-MCT quality may impact fertility and recurrence. By their second year, 98% had performed TLC-MCT, but 73% responded little confidence in their ability to perform the procedure. The most challenging aspects were “initial ovarian incision,” “layer recognition,” and “dissection” (60%), “surgical field control” (47%), and “communication with assistants” (40%).

Conclusions: Early-career gynecologists are generally aware of the impact of technique on fertility. Surgery must be precise to preserve fertility, but inexperienced laparoscopists struggle with aspects of the procedure. To enhance patient outcomes, they must acquire skills without extensive case experience. Besides forceps dexterity training (dry box training), improving layer recognition and strategy by observing expert-led surgeries and videos (visual and cognitive training) is essential.