カルチャースワブを用いたイントロデューサーの作り方－腹腔鏡下手術におけるセプラフィルム貼付の工夫－

抄録

  Adhesions between the abdominal wall and the target organ can be prevented during laparoscopic surgery. However, the anti-adhesion barrier is necessary to prevent adhesion of organs to each other. Seprafilm and Interceed have been used in Japan besides blood products. With Interceed, adhesions will still form if blood remains. Therefore, use of Seprafilm is desirable; however, because Seprafilm is fragile, an appropriate method must be considered when using the Seprafilm in laparoscopic surgery. A variety of using the Seprafilm has been reported in terms of merits and demerits. Here we report a method of making an introducer with an inexpensive culture swab. Culture swabs are sterilized by gamma radiation. The outer diameter corresponds to the inner diameter of 12 mm trocar. Processing is easy as it is made of polyurethane. We used only the outer cylinder of the culture swab. We cut the tip and filled surgical gauze into the lumen in place of the A.P.S. introducer. Each sheet of Seprafilm was divided into 6 pieces, and a total of 182 pieces were inserted into the abdominal cavity for 57 operations. Of the 182 pieces used, 23 (6.7%) were damaged at the time of insertion of the culture swab. We call this method culture swab method. There were no problems in the collection of the samples, because this method does not involve use of a holder when inserting the culture swab into the abdominal cavity. While there was slight damage to the Seprafilm around the culture swab at the time of the insertion, no damage occurred inside the abdominal cavity after insertion. Seprafilm is inexpensive and available everywhere in Japan. Hence, Seprafilm may serve as a useful adhesion barrier.