肥満症例に対する婦人科腹腔鏡手術―第1トロッカー留置におけるオプティカル法の有効性

Gynecologic surgery in obese patients : the effectiveness of optical access trocar for the first entry

◆要旨：Body mass index〔以下，BMI（kg/m²）〕30以上の肥満患者17例を対象とし，トロッカー留置法，トロッカー留置までの時間，周術期結果などを後方視的に検討し，肥満症例に対する婦人科腹腔鏡手術の是非を検証した．第1トロッカー留置法は，Open法6例，Closed法4例，オプティカル法7例であった．そのうち，オプティカル法は第1および全トロッカー留置までの時間が最も短く，スムースに留置可能であった．術式は腹腔鏡下子宮全摘出術，腹腔鏡下筋腫核出術などの難度の高い術式も完遂しえた．術後合併症は発熱を1例に認めたのみであった．BMI30を超える肥満症例に対する婦人科腹腔鏡手術は容認できるものであり，第1トロッカー留置法はオプティカル法が有用であると考えられた．

［Aim］The aim of the present study was to evaluate the feasibility, safety, and complication rates of gynecologic laparoscopic surgery in obese women. ［Methods］ A retrospective study was conducted at the Department of Obstetrics and Gynecology, Nara Medical University, Japan. Seventeen obese women with gynecological disease underwent laparoscopic surgery between April 2008 and April 2012. Women were classified according to their body mass index（BMI）, with a cutoff point of 30 kg/m². We evaluated the way of trocar insertion and complications in obese patients. ［Results］ There were advantages with optical trocar entry（7 cases） when compared with open（6 cases） and closed entry（4 cases）, in terms of speed of entry and rates of failed entry. There were no major organ injuries or complications except for one woman who developed unexplained fever. There was no blood transfusion or conversion to open surgery. ［Conclusion］ The optical access trocar was safe and fast technique for initial trocar placement in gynecologic laparoscopic surgery for obese women.