ロボット支援前立腺全摘除術時に用いたHem-o-lok®クリップが膀胱内に迷入した2例

Intravesical Hem-o-lok clip migration after robot-assisted laparoscopic radical prostatectomy : Two case reports

　今回われわれは，RARPで用いたHem-o-lok^®クリップ（HOLC）が膀胱内へ迷入した2例を経験した．症例1 : 膀胱尿道吻合部の糸が緩んだためHOLCで寄せて縫縮．術後3か月時，膀胱頸部にHOLCの迷入を認めた．症例2 : 膀胱三角部を縫合修復．術後5か月時，同部位に側茎処理で用いたHOLCの迷入を認めた．2例とも無症状で，膀胱癌の経過観察中に偶然に認められた．膀胱尿道吻合部や膀胱縫合部近傍ではHOLCの使用を控えることが望ましい．

Abstract

Hem-o-lok^® clip (HOLC) is used for hemostasis of the lateral pedicles of the bladder in robot-assisted laparoscopic radical prostatectomy (RARP). We report two cases where HOLC used in RARP migrated into the bladder.

Case 1 : In 2018, during the RARP, leakage of cystourethral anastomoses was observed, and the relaxed thread was pulled using HOLC. 3 months after RARP, cystoscopy revealed that HOLC was confirmed at bladder neck.

Case 2 : In 2017, during the RARP, damaged trigone of the bladder wall was sutured. Also, due to leak of cystourethral anastomoses, urethral catheter was placed for 1 month. 5 months after RARP, cystoscopy revealed that HOLC was confirmed at the trigone of bladder.

It is desirable to refrain from using HOLC near the bladder urethral anastomosis and the bladder suture. In addition, it is preferable to device additional sutures for anastomotic leaks (Rinsho Hinyokika 73 : 771-775, 2019).