腹腔鏡下子宮全摘術における摘出検体回収時に意図せず卵巣摘出に至った１例

<p>　In laparoscopic total hysterectomy (TLH), several methods of specimen retrieval exist, including vaginal retrieval, retrieval through a small incision in the abdominal wall and the use of morcellator. While vaginal retrieval does not create new wounds, it demands skill and time, particularly when retrieving a large uterus. It also carries the risk of perineal and vaginal wall lacerations and entrapment of the intestinal tract. In this report, we present a case of inadvertent removal of an ovary during the transvaginal retrieval of the uterus in TLH. The patient, a 50-year-old woman, was referred to our hospital with a diagnosis of uterine fibroids resulting in excessive menstruation. TLH was performed for uterine fibroids. Preoperative imaging and intraoperative findings indicated normal bilateral ovaries, prompting the decision to preserve them. After hysterectomy, the transvaginal retrieval of the uterus was conducted through traction with forceps and using a scalpel and cooper for sectioning. After suturing of the vaginal segment, the patient experienced bleeding from the right pelvic funnel ligament area due to accidental removal of the right ovary, which had become interspersed with fragmented uterine tissue. Upon reviewing the operative video, it became evident that during transvaginal retrieval, the right ovary had been positioned underneath the uterus, leading to tearing of the pelvic funnel ligament as it was pulled into the vagina along with the uterus. During TLH, transvaginal retrieval of the uterus should be performed with extreme care due to the risk of adjacent organs becoming entrapped in the vaginal canal.</p>