title: Seprafilm® Application Method in Laparoscopic Surgery.
abstract: OBJECTIVE
  Postoperative adhesions occur less often in laparoscopies than in laparotomies, but the incidence can be reduced further. Seprafilm, a sodium hyaluronate/carboxymethylcellulose absorbable barrier, was developed to prevent adhesions after abdominal surgery, and is approved for postoperative adhesion prevention. However, Seprafilm is seldom used in laparoscopic surgery because of its tendency to break apart when it is inserted into the abdominal cavity through a trocar, resulting in a high placement failure rate. We propose a better method for applying the adhesion barrier Seprafilm in single- or multiport gynecologic surgery.
  
  
  METHODS
  This is a retrospective analysis of patients who underwent multi- or single-port gynecologic laparoscopies from December 2014 through January 2016 in Buddhist Tzu Chi General Hospital, Hualien, 46 patients received Seprafilm (Genzyme Corp., Cambridge, MA, USA) via the proposed method. A piece of Seprafilm was cut into quarters. To moisten and soften the Seprafilm, each piece was placed on a wet wrung gauze until it became naturally curled. Two pieces of the film were rolled up with the backing paper that came from the package of Seprafilm. Holding the rolled Seprafilm with a grasper, the surgeon delivered it into the abdomen through a 11-mm trocar.
  
  
  RESULTS
  The success rates of Seprafilm insertion and correct placement were 100% (46/46) and 95.7%, respectively. In 2 single-port (2/26) laparoscopic surgeries, the placement of the film failed; all placements in the multiport laparoscopic surgeries were successful (20/20). The average time required for placement of pieces of Seprafilm per surgery was 4.0 ± 1.47 minutes among all surgeries; significantly more time was needed in the single-port surgeries (mean, 4.4 ± 1.59 minutes) than in the multiport surgery (mean, 3.4 ± 1.13 minutes) (P< .05).
  
  
  CONCLUSIONS
  This method of Seprafilm placement is a simple technique that does not need special equipment and ensures a high success rate. The placement of the film takes longer in single-port surgeries than in multiport surgeries.
authors.affiliation: Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Tzu Chi University, and Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
authors.forename: Mun-Kun
authors.initials: MK
authors.lastname: Hong
authors.affiliation: Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Tzu Chi University, and Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
authors.forename: Dah-Ching
authors.initials: DC
authors.lastname: Ding
mesh_terms: D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D006820:Hyaluronic Acid; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008567:Membranes, Artificial; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control*
chemical_list: D008567:Membranes, Artificial; C118198:Seprafilm; D006820:Hyaluronic Acid
keywords: Adhesion barrier; Laparoscopy; Seprafilm; Single-port access