title: Safe primary approach using a micro-laparoscope via the posterior vaginal fornix for patients with previous upper laparotomy: a report of five cases.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Hongo, Tokyo, Japan. kumakiri@jutendo.ac.jp
authors.forename: Jun
authors.initials: J
authors.lastname: Kumakiri
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takeuchi
authors.forename: Mari
authors.initials: M
authors.lastname: Kitade
authors.forename: Iwaho
authors.initials: I
authors.lastname: Kikuchi
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kumakiri
authors.forename: Keiji
authors.initials: K
authors.lastname: Kuroda
authors.forename: Makoto
authors.initials: M
authors.lastname: Jinushi
authors.forename: Satoru
authors.initials: S
authors.lastname: Takeda
mesh_terms: 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