手術既往例に対する腹腔鏡下手術の安全なアプローチ法 : 針状腹腔鏡を用いた第9肋間穿刺法

概要

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Aim: To assess the safety and effectiveness of "ninth costal approach" with microlaparoscopy to avoid bowel injury in patients with previous abdominal surgery. Between January 1997 and June 1999, we performed microlaparoscopy with the "ninth costal approach" prior to umbilical insertion of a trocar in 33 patients. Access was achieved through the left ninth intercostal space with a specially designed metal sleeve through which a Veress needle was inserted. After pneumoperitoneum was achieved, the abdominal cavity was observed with a 2 or 3 mm diameter microlaparoscope. If any adhesions were seen, adhesiolysis was performed prior to insertion of an umbilical trocar. Significant adhesions of the omentum or intestine around the umbilical peritoneal area were seen in 13 women (39.4%). A safe laparoscopic procedure can be performed in patients with previous abdominal surgery using microlaparoscopic "ninth costal approach".
社団法人日本産科婦人科学会の論文
2000-01-01