[Usefulness of newly developed subcutaneous one point lifting method in gynecological laparoscopic operation]

We first introduced the abdominal wall lifting method in gynecological laparoscopic operations in 1994. Now we have developed a new one-point lifting technique (Tokyo Medical College method) that enables gynecological laparoscopic operations to be performed more safely, easily and economically. 1. The TMC method provides a sufficiently spacious operative field in the same way as artificial pneumoperitoneum and can overcome the negative influence of obesity on the operative field. 2. Because the abdominal wall is lifted up by means of a single stainless steel wire passed under the skin in this method, the limitations of previous methods are completely overcome. Furthermore setting up for this method is very easy and can be completed in a short time. 3. Because the aperture for the Surgigrip made in the abdominal wall is short and has a large internal diameter, we can manipulate operative instruments freely. Especially suturing and ligation can be carried out simply and accurately. 4. We were able to continue irrigation and suction without deterioration of the operative field and to easily remove resected tissue from the abdominal cavity. 5. The frequency of intracorporeal suture and ligation in this method increased significantly compared with the pneumoperitoneum method in cases of ovarian diseases. As a result, most operative procedures in ovarian diseases became cystectomies, preserving the healthy part of the ovary. This also reduced operative cost by avoiding expensive autosuture equipment. 6. There were no complications such as subcutaneous bleeding with this method. There was no significant difference between this method and pneumoperitoneum in terms of postoperative pain. The TMC method is a new laparoscopic operative technique that allows procedures to be performed under conditions close to laparotomy procedures and solves most of the problems of the pneumoperitoneum method.