腹腔鏡下子宮亜全摘術の有用性と問題点の検討

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  • Assessment of the usefulness and problems associated with laparoscopic subtotal hysterectomy

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Objective: Among all types of laparoscopic hysterectomies, laparoscopic subtotal hysterectomy (LSH) is a relatively simple and easy procedure. However, LSH is particularly difficult in patients with uterine sarcoma. We retrospectively examined the usefulness and problems associated with this operation in the perioperative period in our institution.<BR>Design: One hundred thirty-two laparoscopic hysterectomies were performed in our institution between 2009 and 2012. Among the 132 cases, we investigated 128 cases (the remaining 4 cases had to be converted to laparotomy). We divided the 128 cases into two groups: LSH (n = 84) and non-LSH (cases that underwent other types of laparoscopic hysterectomies, n = 44). We compared the LSH group with the non-LSH group in terms of age, parity, operative time, amount of bleeding, weight of the resected lesions, postoperative length of stay, and pre- and postoperative hemoglobin levels. Furthermore, we describe two uterine sarcoma cases to address the problems associated with LSH.<BR>Results: The LSH group was superior in terms of operative time, weight of the resected lesions, postoperative length of stay, and pre- and postoperative hemoglobin levels. On the other hand, two cases that were initially diagnosed as uterine myoma underwent LSH. These cases were later histopathologically diagnosed as uterine sarcoma.<BR>Conclusions: In situations where screening of cervical and endometrial cancer is possible, LSH is superior compared to other laparoscopic hysterectomies and reduces the burden on medical personnel and patients in the perioperative period. However, LSH remains difficult in patients with uterine sarcoma, and this problem needs to be resolved in future.

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