Safe primary approach using a micro-laparoscope via the posterior vaginal fornix for patients with previous upper laparotomy: a report of five cases.
In order to reduce the risk of visceral injury for patients with upper abdominal adhesions, we devised an alternative to the umbilical approach. Five patients who had undergone a previous upper abdominal laparotomy and were scheduled for gynecologic laparoscopic surgeries at our hospital were evaluated. A micro-trocar was inserted via the posterior vaginal fornix and the periumbilicus was observed using a micro-laparoscope inserted in the micro-trocar. A trocar for conventional laparoscopy was inserted into the umbilicus under micro-laparoscopic observation in the cul-de-sac to avoid visceral organ adherent to the periumbilicus. Four cases had adhesions of the transverse colon, small bowel or omentum to the upper abdomen due to previous surgery; however, we were able to accomplish laparoscopic surgery without injury to adhesive organs in all patients. The micro-laparoscopic primary approach via the posterior vaginal fornix is a safe primary approach for patients who have undergone a previous upper abdominal laparotomy.
Kumakiri
Jun
J
Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Hongo, Tokyo, Japan. kumakiri@jutendo.ac.jp
Takeuchi
Hiroyuki
H
Kitade
Mari
M
Kikuchi
Iwaho
I
Kumakiri
Yuko
Y
Kuroda
Keiji
K
Jinushi
Makoto
M
Takeda
Satoru
S
D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000075202:Contraindications; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects*; D008875:Middle Aged; D013525:Surgical Instruments; D000267:Tissue Adhesions; D016896:Treatment Outcome; D014472:Umbilicus; D014621:Vagina