Gasless Laparoscopic Surgery Using a New Intra-abdominal Fan Retractor System: An Experience of 500 Cases

Akira, Shigeo; Abe, Takashi; Igarashi, Kenji; Nishi, Yayoi; Kurose, Kouichi; Watanabe, Michiaki; Takeshita, Toshiyuki

doi:10.1272/jnms.72.213

Cited by 14 publications

(7 citation statements)

References 6 publications

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“…In our case, we used a fan-shaped retractor and a sponge-made retractor, which could exclude the small intestine gently over a wide range, and achieved a good surgical view. Similar instruments are used in gasless laparoscopic surgery and are reported to be safe and easy to handle 12 .…”

Section: Discussionmentioning

confidence: 99%

Useful Preoperative Simulation of Laparoscopic Surgery for Rectal Cancer in Patients with Kyphosis

et al. 2022

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Kyphosis makes abdominal surgery difficult. Here, we report a case of rectal cancer in a patient with kyphosis on whom laparoscopic surgery was adequately performed owing to preoperative simulation. An 81-year-old woman with rectal cancer was admitted to our department, and laparoscopic surgery was planned. On physical examination, the patient showed severe kyphosis. To adequately perform laparoscopic surgery, a detailed and thorough preoperative simulation was conducted. 1) Simulations of port arrangement and anatomy with 3-D CT, 2) body position simulation, 3) selection of surgical instruments, 4) preoperative discussion with the anesthesiologist were conducted. We planned to insert the first port from the umbilical region for pneumoperitoneum and the camera port from the ventral region under pneumoperitoneum. We planned to insert the ports on the right side of the patient's body from caudal regions, considering the location of the inferior mesenteric artery and the limited degrees and space due to the costal arch and the promontorium. Beach chair position was planned. We used a fan-shaped retractor and a sponge-made retractor to remove the small intestine from the surgical view. We discussed with the anesthesiologist preoperatively, and decided to keep the pneumoperitoneum pressure under 8 mmHg during the operation considering the respiratory function. Lower anterior resection with D2 lymph node dissection was performed without any intraoperative complications, and at 2 years post-surgery, the patient was healthy with no signs of recurrence. Laparoscopic surgery may be a good

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Section: Discussionmentioning

confidence: 99%

Useful Preoperative Simulation of Laparoscopic Surgery for Rectal Cancer in Patients with Kyphosis

et al. 2022

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“…Gasless laparoscopic surgery has been performed using the full‐thickness wall lift system originally described by Kawamura et al (11), with modifications by Akira et al (12). This full‐thickness wall lift system was selected to provide better intra‐abdominal view than the subcutaneous lift system, especially in obese patients.…”

Section: Methodsmentioning

confidence: 99%

Gasless laparoscopically assisted myomectomy using a wound retraction system

Akira

Ichikawa

Iwasaki

et al. 2011

Asian Journal of Endoscopic Surgery

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“…In our hospital, LAC has been performed as a gasless laparoscopic surgery using the abdominal wall lifting method since 1999. 8 Although LAC is safe and effective, it is performed in only specific areas and limited institutes, including our hospital.…”

Section: Introductionmentioning

confidence: 93%

“…8 In all patients undergoing LAC, a 1-cm umbilical incision was made using an open technique. The laparoscope was introduced into the abdominal cavity through this incision, and three intraabdominal fan retractors were introduced separately through the same incision.…”

Section: Laparoscopic-assisted Cystectomymentioning

confidence: 99%

A new concept of minimally invasive laparoscopic surgery utilizing the vaginal route to prevent iatrogenic spillage of dermoid cysts: The bathtub method

Mine

Ichikawa

Sekine

et al. 2016

Gynecology and Minimally Invasive Therapy

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Keywords: cystectomy dermoid cyst endoscopic bag laparoscopy vaginal trocar a b s t r a c t Objective: Surgical management of dermoid cysts remains controversial, and some surgeons prefer to approach these cysts via laparotomy due to the high risk of intraperitoneal cyst rupture in laparoscopic surgery and the related risks of chemical peritonitis. In our hospital, laparoscopic-assisted cystectomy (LAC) has been performed as a gasless laparoscopic surgery using an abdominal wall lifting method with a 3e5-cm transverse suprapubic incision that enables the dermoid cyst to be approached directly, as in laparotomy. Although LAC is safe and effective, it is performed in only specific areas and limited institutes. Therefore, we developed the "bathtub method," a modified laparoscopic method that uses an endoscopic bag inserted through the vagina. The cyst is enucleated within the bag to catch cyst spillage. We compared results of the bathtub method with those of LAC. Methods: We evaluated 37 patients scheduled for laparoscopic cystectomy with the bathtub method and 37 patients scheduled for LAC. Results: Intraoperative cyst rupture occurred in 22 patients treated with the bathtub method; the majority of the cyst contents spilled into the endoscopic bag. White blood cell count and C-reactive protein level on postoperative Day 1 were 7708.3 ± 1920.0/mL and 0.91 ± 1.0 mg/dL, respectively, for the bathtub method versus 9913.9 ± 2644.9/mL and 2.7 ± 1.9 mg/dL for LAC (p < 0.01 for both). There was no secondary chemical peritonitis in either group. Conclusion: The bathtub method is less invasive than is LAC, with unremarkable scarring and minimum spillage. It is considered safe and useful.

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Gasless Laparoscopic Surgery Using a New Intra-abdominal Fan Retractor System: An Experience of 500 Cases

Abstract: The new intra-abdominal fan retractor system is feasible in gynecologic laparoscopic surgery.

Cited by 14 publications

References 6 publications

Useful Preoperative Simulation of Laparoscopic Surgery for Rectal Cancer in Patients with Kyphosis

Useful Preoperative Simulation of Laparoscopic Surgery for Rectal Cancer in Patients with Kyphosis

Gasless laparoscopically assisted myomectomy using a wound retraction system

A new concept of minimally invasive laparoscopic surgery utilizing the vaginal route to prevent iatrogenic spillage of dermoid cysts: The bathtub method

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