腹部手術既往症例における安全かつ有用な第一穿刺領域の検討

Objective: The umbilical site is widely used as the initial entry site in laparoscopic surgery. The initial entry procedure may cause organ injury, and thus we use the upper abdominal region as the entry site when umbilical site adhesions are suspected. However, the upper abdominal region is far from the pelvis, and therefore use of this region for the entry site makes pelvic surgery challenging. We investigated which abdominal region, other than the umbilical site, would be suitable for the initial entry. Methods: From January 2020 to December 2022, 181 of the 659 patients who underwent laparoscopic or robot-assisted endoscopic surgery at our hospital had a history of abdominal surgery. The presence of organ adhesion to the abdominal wall (umbilical site [US], left upper abdomen [LU], right upper abdomen [RU], left lower abdomen [LL], right lower abdomen [RL], and the midline of the lower abdomen [ML]) was retrospectively examined. Results: The frequency of organ adhesions at each site was US 23.8%, LU 0.5%, RU 3.9%, LL 4.4%, RL 24.8%, and ML 11.0%. The frequency of organ adhesions in the LL was significantly lower than in the US (p < 0.05). There was no significant difference in the frequency of organ adhesions between the LL and ML. Nevertheless, in the presence of US adhesions, the frequency of organ adhesions was significantly lower in the LL than in the ML (p < 0.05). Conclusion: In patients with a history of abdominal surgery, the left lower abdomen is a safe and appropriate initial entry site.