ガスレス腹腔鏡下手術における腹腔内挿入鉤と手動ジャッキを用いた新しい腹壁挙上器

A new abdominal wall lifting instrument with an intra-abdominal fan and manual mechanical jack for gasless laparoscopic surgery

◆要旨：目的：ガスレス腹腔鏡下手術における新しい腹壁挙上器の有用性を報告する．方法：この機器は腹腔内に挿入する2本の鉤とアーム，手動式のジャッキより構成され，腹壁全層を挙上するものである．2本の鉤は単一創より腹腔内に別々に挿入して合体させた後，手動式のジャッキに取り付けたアームに連結させる．結果：1,000例以上の腹腔鏡下胆囊摘出術に使用し，術野不良による開腹移行例はなかった．結論：本機器は炭酸ガス気腹による合併症を解消し，また他の吊り上げ式機器には不可欠なワイヤーがないために腹壁上に手術操作を妨げるものがない．腹腔鏡下手術において腹腔内挿入鉤を用いたこの新しい腹壁挙上器は安全で有用である

Aim : The aim of this study is to report the feasibility of a new gasless abdominal wall lifting instrument for laparoscopic surgery. Methods : This instrument consists of two intra-abdominal fan retractors, a lifting arm, and a manual mechanical jack which lifts up the entire abdominal wall. The retractors are introduced separately through the same incision and assembled in the abdominal cavity, and then attached to the lifting arm which is connected to the manual mechanical jack. Results : More than 1,000 cases of laparoscopic cholecystectomy have been performed using this instrument, of which no cases needed to be converted to laparotomy because of poor operative exposure. Conclusion : The instrument eliminates all complications associated with pneumoperitoneum with carbon dioxide, and never interferes with operative movements owing to the absence of wires above the abdomen, which are indispensable in other hanging retractor systems. The new intra-abdominal fan retractor system is safe and feasible in laparoscopic surgery.