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. 2017 Apr-Jun;6(2):66-68.
doi: 10.1016/j.gmit.2016.12.001. Epub 2017 Jan 16.

Higuchi's transverse incision and a modification of this method for minimally invasive surgery

Aikou Okamoto  1 , Yoko Nagayoshi  1 , Ayako Kawabata  1 , Masaru Sakamoto  2 , Kazu Ueda  1
Affiliations

Higuchi's transverse incision and a modification of this method for minimally invasive surgery

Aikou Okamoto et al. Gynecol Minim Invasive Ther. 2017 Apr-Jun.

Abstract

Study objective: To describe Higuchi's transverse incision and a modification of this method for reduced port surgery (RPS).

Design: Descriptive study.

Setting: University hospital.

Patients: Those with ovarian cyst and uterine myoma.

Intervention: A platform is placed in the 2-3 cm Higuchi incision just above the pubis or on the pubis. Blunt dissection of the subcutaneous adipose tissue is performed. A T incision of the rectus abdominis fascia and a longitudinal incision of the peritoneum are performed. A LAP PROTECTOR and EZ access (Hakko Medical, Nagano, Japan) are used with the platform for single-incision laparoscopic surgery. The peritoneum and fascia are closed by continuous suture, and the skin is closed using the dermostitch technique.

Main results: Higuchi's transverse incision is 2-3 cm in length and is made at a much lower position than the conventional Pfannenstiel transverse incision. The wound is covered by pubic hair, yielding an excellent esthetic outcome. The T incision of the rectus abdominis fascia secures a more extensive surgical field than the Pfannenstiel transverse incision.

Conclusion: Higuchi's modified transverse incision ensures a sufficient visual field, yields an excellent esthetic outcome, and is safe, suggesting the potential use of this method for RPS.

Keywords: Higuchi’s transverse incision; reduced port surgery; single-incision laparoscopic surgery.

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Conflict of interest statement

Conflicts of interest: The authors have no conflicts of interest relevant to this article.

Figures

Figure 1
Figure 1
Higuchi’s original transverse incision for benign tumors and cesarean sections. (A) The incision is made at a low position, 1.5 cm above the pubis. (B) The extensive use of blunt dissection of subcutaneous adipose tissue makes it possible to avoid abdominal wall blood vessel injury. (C) The rectus abdominis fascia incision is bluntly extended from 2 cm to 3 cm cranial to the skin incision line in a transverse direction to the lateral margin of the rectus abdominis. (D) A longitudinal incision is made toward the area directly above the pubic symphysis. (E) The opening of a T incision in the rectus abdominis fascia ensures a sufficient visual field. (F) Treatment of the peritoneum while confirming and separating the bladder from the peritoneum makes it possible to avoid bladder injury. (G) This approach secures a more extensive surgical field than the Pfannenstiel transverse incision. (H–J) The peritoneum and fascia are closed by continuous suture.
Figure 2
Figure 2
Higuchi’s modified transverse incision for low-position single-incision laparoscopic surgery. (A, B) A platform is placed in the 2–3 cm Higuchi incision just above the pubis or on the pubis. (C) Blunt dissection of subcutaneous adipose tissue is performed. (D–F) AT incision of the rectus abdominis fascia is made. (G, H) A longitudinal incision of the peritoneum is performed according to Higuchi’s original transverse incision. (I-1, I-2) Special attention is required to avoid bladder injury. (J) A LAP PROTECTOR and EZ access (Hakko Medical, Nagano, Japan) are used with the platform for single-incision laparoscopic surgery. (K–M) The peritoneum and fascia are closed by continuous suture. (N) The skin is closed with the dermostitch technique. (O) The wound 2 weeks after the surgery. (P) The wound 2 months after the surgery. (Q) The wound is hidden by pubic hair 4 months after the surgery.
See this image and copyright information in PMC

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