牽引糸を用いた新規子宮マニピュレーション法により腹腔鏡下広汎子宮全摘術を行った子宮頸がんの１例

抄録

In laparoscopic radical hysterectomy (LRH) for early-stage cervical cancer, uterine manipulation is essential to expand the surgical field by raising the uterus with appropriate force and direction. On the other hand, a phase III randomized controlled trial reported that minimally invasive surgery such as LRH has a poorer prognosis than laparotomy. The trial also pointed out that the use of a uterine manipulator might be one of the poor prognostic factors and a contraindication. We report a case who underwent LRH using a novel uterine manipulation method instead of a uterine manipulator. The patient was a 69-year-old woman diagnosed with stage IB1 cervical cancer, a usual-type endocervical adenocarcinoma, according to the cone biopsy. After being informed of the treatment options in detail, the patient requested LRH. Thus, we performed LRH with her written consent. The round ligament, fallopian tube, and ovarian ligament were sutured together by a thread at the uterine angle. We guided one end of the thread to the anterior wall of the lower abdomen and another to the contralateral umbilical level for traction. By adjusting the traction force of each traction thread, we could pull the uterus in an arbitrary direction to expand the surgical field. The anatomical structure around the uterine cervix was well confirmed by this method. The operation could be completed without intraoperative complications with a blood loss of 300g. The present case suggests that our approach may be helpful for uterine manipulation in LRH.