Related Experiment Video
Updated: Oct 4, 2025
Author Spotlight: A Reproductive Hysteroscopy Approach for Complete Endometrial Polyp Removal and Enhanced Endometrial Receptivity
Published on: August 2, 2024
Laparoscopic hysterectomy for endometrial cancer after the Fontan procedure: The first case report
Yoshitsugu Chigusa1, Shiro Baba2, Koji Yamanoi1
1Department of Gynecology and Obstetrics, Kyoto University, 54 Shogoin Kawahara cho, Sakyo ku, Kyoto, 606-8507 Japan.
Insights
This case study details the first successful laparoscopic hysterectomy for endometrial cancer in a patient with a Fontan procedure. Careful surgical planning ensured a favorable outcome, demonstrating the feasibility of this approach.
Area of Science:
- Gynecologic Oncology
- Cardiovascular Surgery
- Minimally Invasive Surgery
Background:
- The Fontan procedure is a palliative surgery for single-ventricle congenital heart defects, creating a unique venous anatomy.
- Endometrial cancer is a potential concern in adult patients with complex cardiac histories.
- Managing gynecologic malignancies in Fontan patients presents unique surgical challenges due to altered hemodynamics.
Abstract:
The Fontan procedure is a palliative cardiac surgery performed for children with a single functional ventricle, and its aim is to divert central venous return to the pulmonary artery without passing through the right ventricle. We herein report the first case of endometrial cancer after the Fontan procedure that was successfully treated with laparoscopic hysterectomy. A 38-year-old female who underwent the Fontan procedure at the age of 23 presented with abnormal genital bleeding and was diagnosed with endometrial cancer. Computed tomography revealed distinctive venous vasculature in the pelvis: most of the venous return from the left lower extremity occurred via the extremely distended left ovarian vein. Laparoscopic total hysterectomy and bilateral salpingo-oophorectomy were performed. The pneumoperitoneum was maintained at 8-10 mmHg during the operation so that the high intra-abdominal pressure would not interfere with venous return. In addition, the left ovarian vein was first test clamped to ensure that circulation was maintained and was then resected. Although the volume of blood loss reached 358 ml due to high venous pressure, her postoperative course was favorable, and she had no signs of recurrence at the 12-month follow-up. Our case suggests that laparoscopic hysterectomy might be safe and feasible for patients with endometrial cancer after the Fontan procedure, as long as a preoperative study of pelvic vascularization and intraoperative monitoring of the circulation is carried out.
