臍ヘルニア合併子宮体癌ⅠA期に対し腹腔鏡下手術を行った１例

A 74-year-old woman with BMI of 40.4 visited our hospital with a complaint of vaginal bleeding. Histological examination of the endometrium revealed a grade 1 endometrial carcinoma. Pelvic contrast-enhanced MRI and contrast-enhanced CT showed no obvious myometrial invasion and three cm umbilical hernia, respectively. The preoperative diagnosis was endometrial cancer, stage IA equivalent. A four cm longitudinal incision was made in the right lower abdomen and the intraperitoneal area was observed using laparoscopy. The umbilical hernia was firmly adhered to the hernial orifice and comprised only the great omentum. A five mm camera port was then placed five cm to the right of the umbilicus under laparoscopic observation, and two additional ports were placed in the mid and left lower abdomen in a typical diamond configuration. Although it was difficult to obtain a regular view with a direct laparoscope due to interference between forceps, a total laparoscopic hysterectomy with bilateral adnexectomy was completed using to a flexible laparoscope. She was discharged on the fourth postoperative day. The FIGO stage for the endometrial cancer was stage IA, pT1aNxM0, endometrial carcinoma grade one. No postoperative therapy was administered as risk for recurrence was low. There was no evidence of tumor recurrence 14 months post-surgery. In cases of laparoscopic operation complicated by umbilical hernia, the usual umbilical approach is complicated. However, by placing the camera port on the right side of the umbilicus and using a flexible laparoscopy, it may be possible to perform a laparoscopic surgery, which was equally effective.