A case of robot-assisted hysterectomy followed by left adnexectomy for atypical endometrial hyperplasia and left ovarian teratoma in a severely obese Japanese woman

Hiroshi Ishikawa, Akira Mitsuhashi, Yuji Habu, Makio Shozu
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2020 · vol. 36(1) , pp. 207–212 · doi:10.5180/jsgoe.36.1_207 · W3033280329
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This case report details a successful robot-assisted hysterectomy and adnexectomy for atypical endometrial hyperplasia and a teratoma in a severely obese Japanese woman, noting good tolerance and cosmetic outcomes.

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This single-case report describes a 43-year-old nulliparous severely obese Japanese woman (BMI 50.8) with abnormal uterine bleeding, in whom endometrial biopsy showed atypical endometrial hyperplasia and MRI identified a 7 cm left ovarian teratoma. The authors performed robot-assisted hysterectomy with left adnexectomy and right salpingectomy using the da Vinci Xi system, detailing port placement and noting that the removed uterus and left ovary were removed vaginally without morcellation. The patient had no reported complications and the authors state the four wounds were cosmetically acceptable due to abdominal fat. This paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Robot-assisted hysterectomy for early endometrial cancer and benign gynecologic diseases has been covered by the public health insurance system in Japan since April 2018, and the number of cases has steadily increased. However, few reports exist of robot-assisted hysterectomy in severely obese Japanese women [body mass index (BMI) >50]. Herein, we report a case of robot-assisted hysterectomy followed by left adnexectomy for atypical endometrial hyperplasia and left ovarian teratoma in a Japanese woman with a BMI of 50.8. A 43-year-old nulliparous woman with a height of 161.2 cm and body weight of 132 kg was referred to our facility for the treatment of abnormal uterine bleeding. Endometrial biopsy revealed atypical endometrial hyperplasia, and magnetic resonance imaging revealed endometrial thickness of 23 mm and a left ovarian teratoma of 7 cm. Since the patient was unlikely to undergo a successful future pregnancy, we performed a robot-assisted hysterectomy, left adnexectomy, and right salpingectomy using the da Vinci Xi surgical system. We set four ports at the height of the umbilics, all of which were made along skin striae, and added an assistant port at a point 8 cm above and 8 cm lateral to the umbilics. The excised uterus and left ovary were vaginally removed without morcellation. No complications have occurred, and the four wounds were hidden by abdominal fat; therefore, the patient was satisfied with the surgical outcome. In conclusion, robot-assisted hysterectomy is well tolerated in severely obese Japanese women, and the inconspicuous wounds are cosmetically acceptable.
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症例報告 子宮内膜異型増殖症と左卵巣奇形腫を有するBMIが50.8の高度肥満女性に対し、ロボット支援下子宮全摘および左付属器切除術を施行した1例 2020 年 36 巻 1 号 p. 207-212 詳細 抄録 Robot-assisted hysterectomy for early endometrial cancer and benign gynecologic diseases has been covered by the public health insurance system in Japan since April 2018, and the number of cases has steadily increased. However, few reports exist of robot-assisted hysterectomy in severely obese Japanese women [body mass index (BMI) >50]. Herein, we report a case of robot-assisted hysterectomy followed by left adnexectomy for atypical endometrial hyperplasia and left ovarian teratoma in a Japanese woman with a BMI of 50.8. A 43-year-old nulliparous woman with a height of 161.2 cm and body weight of 132 kg was referred to our facility for the treatment of abnormal uterine bleeding. Endometrial biopsy revealed atypical endometrial hyperplasia, and magnetic resonance imaging revealed endometrial thickness of 23 mm and a left ovarian teratoma of 7 cm. Since the patient was unlikely to undergo a successful future pregnancy, we performed a robot-assisted hysterectomy, left adnexectomy, and right salpingectomy using the da Vinci Xi surgical system. We set four ports at the height of the umbilics, all of which were made along skin striae, and added an assistant port at a point 8 cm above and 8 cm lateral to the umbilics. The excised uterus and left ovary were vaginally removed without morcellation. No complications have occurred, and the four wounds were hidden by abdominal fat; therefore, the patient was satisfied with the surgical outcome. In conclusion, robot-assisted hysterectomy is well tolerated in severely obese Japanese women, and the inconspicuous wounds are cosmetically acceptable. © 2020 日本産科婦人科内視鏡学会

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