手術手技
腹腔鏡下手術における癒着防止吸収性バリア（セプラフィルム®）のφ5 mmトロッカーからの腹腔内搬入の工夫：Cylinder-Roll technique S字法
2018 年 34 巻 2 号 p. 312-317
詳細
2018 年 34 巻 2 号 p. 312-317
Postoperative adhesions can cause complications such as chronic pelvic pain, ileus, and infertility. However, the frequency of these adhesions has been found to decrease with the use of anti-adhesion materials, such as adhesion barriers. An adhesion barrier (Seprafilm®, Kaken Pharmaceutical, Tokyo) is a fragile film that is susceptible to damage by external forces. Thus, for laparoscopic surgery, it is necessary to devise a technique for careful insertion and adherence in the abdominal cavity.
There are many reported techniques for the use of this film in laparoscopic surgery. For example, the Cylinder-Roll technique, which involves loading a film into a cartridge of a Sterilized Lap Sponge (TroX® II-D type, Osaki Medical, Aichi) and inserting it into the abdominal cavity using a 5-mm-diameter trocar. However, the Cylinder-Roll technique has two problems: loading the film into the cartridge and picking up the film with forceps after insertion into the abdominal cavity.
To overcome these problems, we devised a technique in which the film is bent into a cylindrical shape so that the cross-section of the film is S-shaped upon loading it into the cartridge. The cylindrical shape makes loading of the film into the cartridge easy, and the S-shaped cross-section enables insertion and adherence while gripping the film with forceps.
This report includes 30 cases of total laparoscopic hysterectomy performed at the Showa University Hospital and Showa University Northern Yokohama Hospital between April 2016 and March 2017. A total of 120 sheets of Seprafilm® quarter packs were used; 111 sheets were accurately pasted, and the success rate was 92.5%.
The Cylinder-Roll technique is an inexpensive and safe method. Through our modification of this technique, Seprafilm® can be placed more easily, quickly, and accurately in the abdominal cavity and can be applied onto the target site. Thus, the modified S-type Cylinder-Roll technique is considered useful.
