内視鏡下手術におけるセプラフィルムⓇやタコシールⓇの新たな搬入方法の考案

New technique to facilitate insertion of adhesion barrier（SeprafilmⓇ） and tissue sealing sheet（TachoSilⓇ） into abdominal cavity for laparoscopic surgery

◆要旨：内視鏡下手術における，セプラフィルム^®やタコシール^®搬入を容易にするため，新しいデバイスを考案した．このデバイスを腹腔鏡下子宮筋腫核出術における，セプラフィルム^®およびタコシール^®の搬入に用いた．セプラフィルム^®のCS-PCパック（12.7×7.4cm）を12例，タコシール^®ハーフサイズ（4.8×4.8cm）を3例に使用した．セプラフィルム^®の貼付時間は平均3.3分（2.0～5.5分），タコシール^®は平均5.0分（4.0～6.0分）であった．いずれも容易に装塡することができ，破損例は1例もなかった．従来の報告より，確実かつ大きなサイズでの搬入が可能となり，内視鏡下手術におけるセプラフィルム^®やタコシール^®の搬入が容易であった．

Seprafilm^®, an adhesion barrier in sheet form, and TachoSil^®, a tissue sealing sheet are very difficult to insert into the abdominal cavity during laparoscopic surgery. Therefore, we created a new device that facilitated the insertion of Seprafilm^® and TachoSil^® into the abdominal cavity through a 12mm diameter trocar. We used this device during a laparoscopic myomectomy in 12 cases with Seprafilm^® and 3 cases with TachoSil^®. Seprafilm^®, measuring 12.7 ×7.4 cm, and TachoSil^®, cut into 4.8×4.8cm pieces, were attached to the inner tube, rotated into the outer tube through a slit configuration, and then inserted through the 12mm trocar. The average time of Seprafilm^® required from the beginning of loading procedure into the device until the attachment to uterus was 3.3 min（2.0-5.5 min） ; for TachoSil^®, the required time was 5.0 min（4.0-6.0 min）. Both were less than that reported in previous studies. Additionally, the success rates of insertion and attachment to the uterus were almost perfect. We, therefore, considerd that this new device may be more effective for the insertion of Seprafilm^® and TachoSil^® into the abdominal cavity than other techniques.