パウチ内モルセレーション法を用いた腹腔鏡下子宮筋腫核出術中の組織片飛散防止の工夫

Abstract

The use of a power morcellator during laparoscopic myomectomy has been reported to be associated with the development of so-called parasitic myomas due to the dissemination and survival of morcellated tissue into the abdominal cavity. The U.S. Food and Drug Administration (FDA) released a safety communication, which stated that the agency discourages the use of a laparoscopic power morcellation during a hysterectomy or myomectomy due to the risk of disseminating unsuspected malignant tissue. Based on this situation, we developed a method to safely use the power morcellator in which tissue fragment dissemination is prevented. A fibroid was separated from the uterus with the use of a retrieval bag, and delivered from the abdominal using a power morcellator under direct vision with the pouch of the retrieval bag fully open. Using this method, no dissemination of tissue fragments was observed. The patient was diagnosed with an apoplectic leiomyoma. This is a rare histological type accompanied by petechial bleeding and the accumulation of infarcts in the fibroid; it differs from the most common type of leiomyoma. This case was diagnosed as a benign tumor; however, malignant uterine tumors cannot be excluded in some cases. Our method is useful not only for the prevention of parasitic tumors, but also when unsuspected malignant uterine tumors are encountered.