手術経験が全腹腔鏡下卵巣嚢胞性奇形腫切除術の手術成績に与える影響について

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Objective: To compare one surgeons outcomes involving total laparoscopic cystectomies (TLCs) for mature ovarian cystic teratomas between two time periods (1995-1998 and 2007-2008). Design: Retrospective study (Canadian Task Force Classification III). Setting: Two university hospitals.Patients: Sixty-three women with mature cystic teratomas.Interventions: Women who underwent TLCs in 1995-1998 or 2007-2008 for mature cystic teratomas.Main outcome, Measures: We determined the age of the patient, diameter of the tumor, surgical time, blood loss, intra-operative leakage, and post-operative hospital stay, Results: In 32 women, 38 mature cystic teratomas were treated by TLC during 1995-1998 (group A). In 31 women, 32 mature cystic teratomas were treated by TLC during 2007-2008 (group B). The 70 mature cystic teratomas were performed by one surgeon (the first author). The incidence of intra-operative leakage was significantly decreased in group B compared to group A (2 vs. 16, P<0.001) and the post-operative hospital stay was significantly shorter in group B compared to group A (mean, 4.0 vs. 6.6 days, P<0.001). The age of the patients, diameter of the tumor, surgical time, and blood loss were not significantly different between groups A and B. Conclusion: Increased laparoscopic surgical experience was significantly associated with a decreased incidence of intra-operative leakage during TLC, and may reflect advances in laparoscopic instrumentation.