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.