腹腔鏡下鼠径ヘルニア修復術（TAPP法，環状切開法）においてメッシュ展開を容易にする腹側腹膜の吊り上げ手技

A new method of lifting the peritoneum after circular incision in TAPP provides better vision in placement of the mesh

◆要旨：腹腔鏡下鼠径ヘルニア修復術（TAPP法）において腹膜の切開剝離の方法として日本では環状切開法が広く行われている．その利点として精巣動静脈や輸精管の認識の容易さなどがあるが，一方でメッシュ展開時に剝離した腹側腹膜が垂れ下がり，特に修練医では視野の妨げとなりやすい．本報告の腹膜吊り上げ法では，腹膜前腔剝離後に腹側腹膜を簡便な方法で吊り上げることでメッシュ展開時の視野と操作性を改善する．腹側剝離部の腹壁から3-0ナイロン糸を通した23Gカテラン針を2回刺通することで，ナイロン糸により腹側腹膜を吊り上げる工夫を行っている．本法により良好な視野のもと修練医でも確実なメッシュ展開が可能となる．

　In Japan, the circular incision method is widely used as a method for dissecting the peritoneum in laparoscopic inguinal hernia repair（TAPP method）. Its advantages include the ease of recognizing the testicular vessels and the vas deferens, and preservation of the dorsal nerve plexus. On the other hand, when the mesh is placed, the detached ventral peritoneum hangs down, which tends to obstruct the field of vision, especially for trainee surgeons. The peritoneal lifting method described in this report significantly enhances visualization during mesh placement. This is achieved through a simple technique that lifts the ventral peritoneum following the dissection of the preperitoneal space. The hanging ventral peritoneum can be lifted by inserting a 23G needle and 3-0 nylon thread twice. This method allows even trainee surgeons to place the mesh more easily and reliably.