title: A novel procedure for introducing large sheet-type surgical material with a self-expanding origami structure using a slim trocar (chevron pleats procedure).
abstract: Large sheet-type surgical materials (e.g., absorbable hemostat, adhesion barrier membranes, and flat surgical mesh) are difficult to introduce into a corporeal cavity using a 5-mm trocar; however, laparoscopic surgeries that use mainly 5-mm trocars are increasing. Furthermore, it is necessary not only to introduce but also to secure the applied surgical material and expand it from the original surgical site. To address these challenges, we developed a novel procedure for introducing such surgical materials into a corporeal cavity using a 5-mm trocar and a self-expanding origami structure, called the "chevron pleats procedure (CPP)".
  
  
  
  We used CPP in 114 cases of laparoscopic surgery for gastrointestinal diseases. The chevron folding pattern is an excellent origami structure and compactly folds a large sheet of material for use with a slim trocar. Surgical materials were folded using a chevron pleats pattern and inserted into a novel, slim, long syringe-type device, which was made from a specially ordered precision polypropylene tube, for introduction into a corporeal cavity. When the surgical material was used, the end of the device was placed above the surgical site and the inner rod was pushed. The surgical material was securely injected and expanded over the surgical site.
  
  
  
  Surgical materials were introduced smoothly and securely using a 5-mm trocar to a site of intraoperative bleeding, the incisional surface of the liver, and defects of the abdominal wall or peritoneum. Efficient hemostasis was attained, the introduction and expansion of surgical mesh was made simpler, and the covering of defects of the peritoneum with adhesion barrier membranes, which is typically difficult during laparoscopic surgery, was easily performed.
  
  
  
  CPP is a basic utility procedure for introducing several sheet-type surgical materials into a corporeal cavity with a 5-mm trocar and might help ensure efficient and safe laparoscopic surgery.
authors.affiliation: Department of Digestive Surgery, Nara City Hospital, 1-50-1 Higashikidera-cho, Nara, Nara, 630-8305, Japan. yuen-n@koto.kpu-m.ac.jp.
authors.forename: Yuen
authors.initials: Y
authors.lastname: Nakase
authors.affiliation: Department of Digestive Surgery, Nara City Hospital, 1-50-1 Higashikidera-cho, Nara, Nara, 630-8305, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Nakamura
authors.affiliation: Department of Digestive Surgery, Nara City Hospital, 1-50-1 Higashikidera-cho, Nara, Nara, 630-8305, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Sougawa
authors.affiliation: Department of Digestive Surgery, Nara City Hospital, 1-50-1 Higashikidera-cho, Nara, Nara, 630-8305, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Nagata
authors.affiliation: Department of Digestive Surgery, Nara City Hospital, 1-50-1 Higashikidera-cho, Nara, Nara, 630-8305, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Mochizuki
authors.affiliation: Department of Digestive Surgery, Nara City Hospital, 1-50-1 Higashikidera-cho, Nara, Nara, 630-8305, Japan.
authors.forename: Shouzo
authors.initials: S
authors.lastname: Kitai
authors.affiliation: Department of Digestive Surgery, Nara City Hospital, 1-50-1 Higashikidera-cho, Nara, Nara, 630-8305, Japan.
authors.forename: Seishirou
authors.initials: S
authors.lastname: Inaba
mesh_terms: D034861:Abdominal Wall; D004867:Equipment Design / Q000639:trends; D005767:Gastrointestinal Diseases; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D010537:Peritoneum; D011126:Polypropylenes; D013525:Surgical Instruments; D013526:Surgical Mesh / Q000639:trends; D016896:Treatment Outcome
chemical_list: D011126:Polypropylenes
keywords: Hemostasis; Introducing procedure; Laparoscopic surgery; Origami technology; Preventing adhesion; Surgical materials