輸血拒否患者に対する婦人科内視鏡手術の経験

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  • Laparoscopic surgery for gynecologic disease in Jehovah's witness patients

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Objective: The refusal of a blood transfusion, by Jehovah's witnesses for religious reasons, becomes problematic when an extended surgical procedure is recommended. The purpose of the current study is to investigate the safety and efficacy of laparoscopic surgery for gynecologic disease in Jehovah's witness patients.<BR>Methods: During the 28 years from 1984 to 2011, gynecologic operation was performed in 54 Jehovah's witness patients. Of these, laparoscopic surgery was performed in five patients (age range 27-63) with ovarian tumor. The clinical features were examined retrospectively.<BR>Results: Three women had unilateral ovarian cystectomy, and bilateral ovarian cystectomy and unilateral salpingo-oophorectomy was performd in one patient each. Operating times ranged from 90 to 225 minutes, and intraoperative total blood loss ranged from a small amount (<20ml) to 550ml. The final pathologic examination revealed three cases of endometrial cyst, one mature cystic teratoma, and one mucinous cystadenoma. The postoperative course was uneventful ; all patients were discharged from the hospital three to five days after operation.<BR>Conclusion: Full informed consent and careful perioperative management should be performed for Jehovah's witness patients. A clear and satisfactory preoperative informed consent is provided to both patients and relatives in our University hospital. Laparoscopic surgery is considered to be a useful procedure for gynecologic disease in Jehovah's witness patients. This minimally invasive surgery is usually performed with a small amount of blood loss. However, we should convert to open surgery immediately if unexpected hemorrhaging occurrs.

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