開腹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

Safe Microlaparoscopy Method for Patients with Previous Abdominal Surgery

　腹式帝王切開術既往例の腹腔鏡下手術で，第1穿刺トロッカーによる横行結腸の穿孔を経験した．これをもとに，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として細型腹腔鏡を用いた第9肋間穿刺法を開発した。49例の手術既往例の腹腔鏡下手術に本法を施行して19例（38.8％）に臍輪直下の腹膜への腸管または大網の癒着を確認し，すべての症例に安全な腹腔鏡下手術を行うことができた．

We have experienced a case of transverse colon perforation in LAVH who had previous cesarian section. The“ninth costal approach”with microlaparoscopy was designed to avoid bowel injury in patients with previous abdominal surgery. We performed microlaparoscopy with the“ninth costal approach”prior to umbilical insertion of a trocar in 49 patients. Significant adhesions of the omentum or intestine around the umbilical peritoneal area were seen in 19 patients (38.8%). All patients with previous surgery have undergone laparoscopic procedure safely using microlaparoscopic“ninth costal approach”.