The cul-de-sac packing method with a metreurynter in gynecologic gasless laparoscopy

Takashi Murakami, Kousuke Yoshinaga, Ryo Konno, Yukihiro Terada, Hiroshi Nabeshima, Rui Sawada, Nobuo Yaegashi, Kunihiro Okamura

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Laparoscopic surgery has inherent restrictions with respect to the operative field of view and the range of surgical manipulation. Of the two procedures which secure sufficient operative space, the operative view of the gasless method is inferior to that of a pneumoperitoneum. In order to gain greater surgical visualization in gynecological gasless laparoscopy, the authors devised the cul-de-sac packing method employing a metreurynter, an instrument familiar to obstetricians in Japan. A metreurynter was lead into the cul-de-sac, and was inflated with saline, which resulted in the adnexae being raised up. This method was performed in three patients whose preoperative diagnoses were unknown infertility, ovarian cyst, and ectopic pregnancy, respectively. In all cases this method was able to keep the bowels out of the cul-de-sac space. In the first case, we were able to perform a tubal patency test under tension-free conditions, while at the same time bilateral tubal information could be obtained in a single view. In the latter two cases the adnexal lesions were maintained at an inspectional position throughout the operation without the necessity of being held by forceps to prevent them from falling down into the cul-de-sac space. No complications occurred in our three cases. This method will not be useful for patients whose cul-de-sac space is closed due to adhesions. However, except in such cases, this technique supplies a good operative view while being simple, safe, and inexpensive. Furthermore, this method supports gentler and less traumatic manipulation throughout the operation.

Original languageEnglish
Pages (from-to)133-138
Number of pages6
JournalTohoku Journal of Experimental Medicine
Issue number3
Publication statusPublished - 2002 Jul 1


  • Gasless laparoscopy
  • Metreurynter
  • Surgical instrument

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)


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