title: A novel method of ninth-intercostal microlaparoscopic approach for patients with previous laparotomy.
abstract: BACKGROUND
  To evaluate the availability of a primary laparoscopic approach for a patient with previous laparotomy and to assess postoperative adhesion to the abdominal wall..
  
  
  METHODS
  A total of 172 patients with a history of laparotomy who were undergoing laparoscopic surgery in our hospital were evaluated. The primary trocar insertion was performed via the ninth-intercostal microlaparoscopic approach for these patients.
  
  
  RESULTS
  This procedure could be performed on all patients and there were no complications. Postoperative abdominal wall adhesion was found in 53 (30.8%) of 172 patients, and periumbilical adhesion was found in 16 patients (9.3%). Among the 172 patients, 150, 19, and three patients had undergone laparotomy once, twice, and thrice, respectively, prior to this study. Considering the number of previous laparotomies, the frequency of periumbilical adhesion was 5.3% (eight of 150 patients), 36.8% (seven of 19 patients), and 33.3% (one of three patients), respectively. Among 150 patients who had undergone laparotomy once, the type of laparotomy was an obstetric-and-gynecologic surgery in 126 patients and other surgeries in 24 patients. There was no significance in the frequency of adhesion between types of previous laparotomies. Surgical incisions were classified as median infra-umbilical incision (94 patients), median supra-umbilical incision (three patients), Pfannenstiel's incision (33 patients), para-rectal incision (15 patients), and peri-rectal incision (five patients). A high frequency of periumbilical adhesion was recognized in the all three median supra-umbilical incisions.
  
  
  CONCLUSIONS
  Ninth-intercostal microlaparoscopic approach is safe for laparoscopic surgery in patients who have undergone laparotomy previously, and this procedure could prevent the risk of bowel injury.
authors.affiliation: Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Hongo, Tokyo, Japan. kumakiri@med.juntendo.ac.jp
authors.forename: Jun
authors.initials: J
authors.lastname: Kumakiri
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takeuchi
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Sato
authors.forename: Mari
authors.initials: M
authors.lastname: Kitade
authors.forename: Iwaho
authors.initials: I
authors.lastname: Kikuchi
authors.forename: Hiroto
authors.initials: H
authors.lastname: Shimanuki
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Kinoshita
mesh_terms: D034861:Abdominal Wall; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004066:Digestive System Diseases / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects*; D008875:Middle Aged; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000453:epidemiology* / Q000473:pathology; D014472:Umbilicus