Modified Novel Technique for Improving the Success Rate of Applying Seprafilm by Using Laparoscopy

Study Objective: To describe a modified surgical procedure for applying the adhesion barrier Seprafilm laparoscopically. Design: Retrospective analysis with videos and illustrations showing laparoscopic application of Seprafilm. Setting: University hospital. Patients: Women undergoing fertility-sparing laparoscopic surgery (myomectomy, endometriotic ovarian cyst or dermoid cyst enucleation, and tuboplasty) via a modified technique. Intervention: Two layers of Seprafilm with plastic covering were rolled together and delivered through a 10-mm trocar, and an irrigation tube was used to moisten the Seprafilm and cover the irregular postoperative rough surface of the organ. After application of Seprafilm, the patient was placed in a reverse Trendelenburg position to check whether the Seprafilm remained in situ on the target surgical surface to act as a physical bather to adhesion development. Measurements and Main Results: After changing the patient's position, illustrations and videos showed that the Seprafilm remained on the postoperative surgical surface, creating a site-specific physical bather. On day 4 after myomectomy, second-look laparoscopy in 2 patients showed that the Seprafilm had become gel-like and remained between the intestine and posterior rough surface of the uterus. There were no systemic second-look laparoscopic data Conclusion: It is feasible and easier to apply Seprafilm adhesion barrier laparoscopically using the modified technique. Further studies are warranted to prove its efficacy after such use. (C) 2014 AAGL. All rights reserved.