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◆要旨:症例は86歳,女性.主訴は直腸脱.受診時,直腸脱に加えて子宮脱,膀胱瘤の骨盤臓器脱を合併していた.同時手術を行う方針とし,院内の高難度新規医療技術等審査委員会で「ロボット支援下仙骨腟固定術と同時に行う場合に限ってのロボット支援下直腸挙上固定術」の実施承認後に本人および家族からインフォームド・コンセントを得た.全身麻酔下砕石位とし,当院婦人科と合同でda Vinci Siを用いた仙骨腟固定術と直腸挙上固定術(Wells変法)を同時に行った.手術時間6時間5分,出血量は18gであった.術後排尿時に迷走神経反射と思われる一時的な意識消失を認めたが保存的加療で軽快し,第14病日に自宅退院した.本邦で初めて骨盤臓器脱合併直腸脱に対してロボット支援下に仙骨腟固定術と直腸挙上固定術を同時に行った報告であり,安全に手術を完遂できた.
We report the first robot-assisted posterior rectopexy with mesh(modified Wells' Method) and sacrocolpopexy for coexisting rectal and pelvic organ prolapse in Japan. An 86-year-old woman was diagnosed with rectal and uterine prolapse and vaginal cystocele due to pelvic organ prolapse. We obtained approval for the operation from our Institutional Review Board's Ethics Committee, and consent for operation from the patient and her family. Two different robotic surgeries, posterior rectopexy and sacrocolpopexy were simultaneously performed. The operative time was 365 minutes, and blood loss was 18ml. No serious postoperative complications occurred, and the postoperative hospital stay was 14 days. The operation was safely completed.
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