⚙
AI-generated deep summary
by claude@2026-06, 2026-06-07
· read from full text
ⓘ
The paper describes an institutional experience with total laparoscopic hysterectomy (TLH) in a single difficult case: a 48-year-old woman with a cervical leiomyoma complicated by endometriosis and suspected adhesions, with a history including left adnexectomy for endometriosis and two cesarean sections. Using MRI findings (bladder compression by the fibroid and suspected Douglas pouch adhesions), the team proceeded with TLH after discussing possible conversion to open surgery, employing a uterine transilluminator and a fluorescent ureteral catheter; three surgeons completed the operation without complications, but the surgery time was prolonged to 8 hours 21 minutes. As limitations, the report is based on one case and therefore only proposes new internal measures for handling difficult TLH (preoperative difficulty evaluation with consideration of open or expert-led TLH, and timed intraoperative “time-outs”) to be assessed in the future. Relevance to endometriosis: the case specifically involves endometriosis complicated by cervical fibroid, including prior endometriosis-related adnexectomy and endometriosis-associated adhesions affecting TLH difficulty, though the paper’s main focus is institutional approaches to difficult TLH cases.
Abstract
At our hospital, we have incrementally expanded the indications for total laparoscopic hysterectomy (TLH) since its introduction in 2019. We report on our experience with a patient who had TLH for a cervical fibroid complicated by endometriosis, which resulted in a surgery of more than eight hours. Through this case, we considered the indications and approach for TLH within our institution. The patient was a 48-year-old female with two previous childbirths and her medical history included left adnexectomy due to endometriosis and two cesarean sections. The patient presented to our department with a chief complaint of persistent urinary frequency over several years. Magnetic resonance imaging revealed a cervical fibroid compressing the bladder and suspected adhesions in the pouch of Douglas. After explaining the possibility of conversion to open surgery and obtaining consent, the decision was made to proceed with TLH using a uterine transilluminator and a fluorescent ureteral catheter. TLH was performed by three doctors without complications, but the operating time was significantly prolonged to 8 hours and 21 minutes. In light of this case, we considered establishing institutional standards for TLH, focusing on the following two new approaches: (1) Conducting a preoperative evaluation for patients where TLH might be difficult, and considering open surgery or TLH under the guidance of an expert, if necessary; (2) Implementing timely time-outs during the procedure. We aim to assess the effectiveness of these measures in the future.
Full text
6,086 characters
· extracted from
oa-html
· click to expand
WEKO3
アイテム
TLH困難症例に対する施設内の新しい試み
http://hdl.handle.net/10271/0002000762
http://hdl.handle.net/10271/00020007624acc3814-9286-4f08-8e27-1e54b0c0b9e5
| 名前 / ファイル | ライセンス | アクション |
|---|---|---|
|
jsog_14_1_10.pdf (802 KB)
|
|
| アイテムタイプ | 共通アイテムタイプ_v2(1) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 公開日 | 2026-04-30 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| タイトル | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| タイトル | TLH困難症例に対する施設内の新しい試み | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| タイトル | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| タイトル | New Institutional Approaches for Difficult Cases with Total Laparoscopic Hysterectomy | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 言語 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 言語 | jpn | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 著者 |
高橋, 慎治
× 高橋, 慎治
× 栗田, 綾花
× 中野, 史織
× 丸山, 享子
× 林, 立弘
× 松井, 浩之
× 芹沢, 麻里子
× 岡田, 喜親
× 小林, 隆夫
× 中山, 毅
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| アクセス権 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| アクセス権 | open access | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| アクセス権URI | http://purl.org/coar/access_right/c_abf2 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| キーワード | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 主題 | prolonged surgery | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| キーワード | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 主題 | cervical leiomyoma | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| キーワード | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 主題 | endometriosis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| キーワード | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 主題 | total laparoscopic hysterectomy | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 資源タイプ | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 資源タイプ識別子 | http://purl.org/coar/resource_type/c_6501 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 資源タイプ | journal article | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 書誌情報 |
ja : 静岡産科婦人科学会雑誌 en : Journal of the Shizuoka Society of Obstetrics and Gynecology 巻 14, 号 1, p. 10-16, 発行日 2026-04-30 |
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 出版者 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 出版者 | 静岡産科婦人科学会 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 抄録 / 注記 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 内容記述タイプ | Abstract | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 内容記述 | 当院では、腹腔鏡下子宮全摘（total laparoscopic hysterectomy: TLH）を2019年から適応を徐々に拡大しながら導入を行ってきた。今回、子宮内膜症を合併した頸部筋腫の症例に対し、手術時間が8時間を超えたTLHを経験した。本症例を通して施設内でのTLHの適応や進行のあり方を考察した。症例は48歳、2産。既往歴は、内膜症による左付属器切除と2度の帝王切開がある。数年前から続く頻尿を主訴に当科を受診した。MRI検査により膀胱を圧排する頸部筋腫と、ダグラス窩の癒着を疑う所見が認められた。開腹移行の可能性について説明し同意を得た上で、子宮トランスイルミネーターや蛍光尿管カテーテルを使用しTLHの方針とした。執刀は3名の医師で対応し合併症なくTLHを完遂できたが、手術時間が8時間21分と大幅に延長した。本症例を鑑みて、TLHの適応や手術の進捗状況の確認について施設内基準を考えてみた。①術前にTLH困難事例の評価を行い、評価次第では開腹手術ないしは指導医主導のTLHを考慮する、②術中に適時タイムアウトを行うという二つの新たな試みを行う方針とした。今後は、この取り組みが有効であるかを確認していきたい。 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 抄録 / 注記 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 内容記述タイプ | Abstract | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 内容記述 | At our hospital, we have incrementally expanded the indications for total laparoscopic hysterectomy (TLH) since its introduction in 2019. We report on our experience with a patient who had TLH for a cervical fibroid complicated by endometriosis, which resulted in a surgery of more than eight hours. Through this case, we considered the indications and approach for TLH within our institution. The patient was a 48-year-old female with two previous childbirths and her medical history included left adnexectomy due to endometriosis and two cesarean sections. The patient presented to our department with a chief complaint of persistent urinary frequency over several years. Magnetic resonance imaging revealed a cervical fibroid compressing the bladder and suspected adhesions in the pouch of Douglas. After explaining the possibility of conversion to open surgery and obtaining consent, the decision was made to proceed with TLH using a uterine transilluminator and a fluorescent ureteral catheter. TLH was performed by three doctors without complications, but the operating time was significantly prolonged to 8 hours and 21 minutes. In light of this case, we considered establishing institutional standards for TLH, focusing on the following two new approaches: (1) Conducting a preoperative evaluation for patients where TLH might be difficult, and considering open surgery or TLH under the guidance of an expert, if necessary; (2) Implementing timely time-outs during the procedure. We aim to assess the effectiveness of these measures in the future. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 収録物識別子 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 収録物識別子タイプ | EISSN | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 収録物識別子 | 2187-1914 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 出版タイプ | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 出版タイプ | VoR | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| 出版タイプResource | http://purl.org/coar/version/c_970fb48d4fbd8a85 |
Text is read by the "Ask this paper" AI Q&A widget below.
Extraction quality varies by source — PMC NXML preserves structure
cleanly, OA-HTML may include some navigation residue, and OA-PDF can
have broken hyphenation. The publisher copy
is the canonical version.