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Safe primary approach using a micro‐laparoscope via the posterior vaginal fornix for patients with previous upper laparotomy: A report of five cases
Author(s) -
Kumakiri Jun,
Takeuchi Hiroyuki,
Kitade Mari,
Kikuchi Iwaho,
Kumakiri Yuko,
Kuroda Keiji,
Jinushi Makoto,
Takeda Satoru
Publication year - 2010
Publication title -
journal of obstetrics and gynaecology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 50
eISSN - 1447-0756
pISSN - 1341-8076
DOI - 10.1111/j.1447-0756.2009.01095.x
Subject(s) - medicine , laparotomy , umbilicus (mollusc) , surgery , laparoscopy , fornix , abdomen , laparoscopic surgery , vagina , hippocampus , endocrinology
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.