肥満症例に対する腹腔鏡手術でのコッヘル鉗子を用いたoptical法の有用性

抄録

Objective: To evaluate the efficacy of optical access trocar with Kocher clamps in obese women.

Methods: We retrospectively analyzed 24 women who underwent gynecological laparoscopic surgery at the Nara Medical University from April 2008 to September 2015 and whose body mass index was over 30 kg/m². We inserted the first trocars by open access, closed access or optical access. In the course of this period, we modified optical access using Kocher clamps. The first step of optical access is to make an incision from the navel to the transversalis fascia, this was similar to open access. The next step includes pulling up the edge of the transversalis fascia using Kocher clamps. We evaluated the differences between the insertion methods.

Results: There were advantages in using optical access with Kocher clamps. One advantage was the significantly shorter time required to insert the first trocar compared with that required using open access (p = 0.0094). The frequency of failure to enter using optical access with Kocher clamps was also significantly lower compared with that of failure using other insertion methods (p = 0.0251). In addition, we observed no major organ injuries and required no blood transfusions.

Conclusion: Optical access trocar with Kocher clamps is a safe and fast technique for insertion of the first trocar during gynecologic laparoscopic surgery in obese women.