Analysis Of 982 Cases Of Open Laparoscopic Trocar First Puncture

Laparoscopic surgery, as a minimally invasive surgical method, has the advantages of less damage, faster recovery and less pain, and has been gradually accepted by the majority of medical workers and patients. Entering the abdominal cavity is the first operation step of laparoscopic surgery, and it is also the first step of successful laparoscopic surgery, and it is also the most dangerous part of the operation. Therefore, a simple, safe and effective first puncture method is necessary for laparoscopy. 982 cases of gynecological laparoscopic application of open gynecological surgery laparoscopic trocar (trocar) first puncture technique in our hospital are as follows.

1 Material and methods

1.1 Clinical data

From October 2004 to October 2006, 982 gynecological patients who underwent laparoscopic open trocar first puncture in our hospital were collected. Gynecological diseases include ovarian cysts, uterine fibroids, infertility, ectopic pregnancy, endometriosis, etc. The youngest is 25 years old and the oldest is 56 years old. The average age is 31 years old.

1.2 Surgical methods

Routine disinfection and sterile drape were performed for endotracheal intubation + intravenous anesthesia. Take the center of the lower edge of the umbilical wheel and make an incision. The main knife and assistants lift the skin on both sides of the umbilical part forward and use the knife tip to cut the skin longitudinally from the bottom of the umbilical hole to the pubic bone about 1cm long. Insert the knife handle vertically downward into the incision, bluntly separate the subcutaneous fat to the fascia, hold the end of the trocar in the palm of the right hand, insert it into the incision, and then pierce the abdominal cavity vertically. There is a sense of disappointment. When the puncture needle and trocar enter the abdominal cavity, first pull out the puncture needle and then push down the trocar 2-3 cm, pull out the puncture needle and place it in the laparoscope to observe and confirm that the laparoscope has been placed in the abdominal cavity without injury and bleeding, and then inflate carbon dioxide gas to establish pneumoperitoneum Perform surgery.

2 Results

This group of cases took about 4.5 minutes from skin incision to complete establishment of pneumoperitoneum and laparoscopic surgery for gynecological surgery. The success rate of the operation was 100% without subcutaneous emphysema and subcutaneous hematoma. There was no puncture injury to the omentum, bowel, blood vessels, or other complications. Only 1 case of omental leakage was cured after secondary suture. 3 Discussion In 1938, Veress et al invented the pneumoperitoneum needle to form pneumoperitoneum through the pneumoperitoneum needle. Blind puncture and gas injection with a pneumoperitoneum needle can cause a series of complications. Liu Yan [1] reported that the retroperitoneal large blood vessel injury caused by the first puncture of laparoscopic surgery was 0∙05% to 0∙11% and even caused death. Yodel et al. [2] calculated that the complications of pneumoperitoneum needle puncture can be as high as 14%. Major complications such as gastric perforation, iliac vascular injury, omentum, and bowel injury, while the complications of open trocar puncture are only 0.9%. trocar puncture is a safe and effective alternative to pneumoperitoneum needle puncture. The open trocar first puncture technique is obviously superior to the method of blind puncture after the formation of pneumoperitoneum by pneumoperitoneum needle puncture.

3 Advantages

(1) The success rate of open trocar puncture is high. In this study, the success rate was as high as 100%. Wu Yunyan et al. [3] reported that 685 cases (97.86%) of 700 patients underwent laparoscopic surgery successfully. 14%) without puncture failure.

(2) Avoid the complications caused by the pneumoperitoneum needle and reduce the first puncture step and the first puncture complications.

(3) The operation time is short and the operation method is simple. It is only necessary to cut all layers of the abdominal wall into the abdomen and directly send the trocar into the laparoscope at the same time as the establishment of pneumoperitoneum. The pneumoperitoneum needle puncture requires the formation of pneumoperitoneum before inserting the puncture trocar into the laparoscope.

(4) Reduce the fear of doctor puncture. Especially for beginners, the method is easy to learn and easy to master, which is beneficial for beginners to carry out laparoscopic surgery smoothly.

(5) High safety Open trocar puncture is performed almost without resistance. The umbilical wheel is cut to reduce puncture resistance or puncture without resistance is safe and easy to master.

(6) Easy to promote. The safety of the first puncture of the umbilicus can be improved after the first puncture of the laparoscopic surgical trocar. The operation can be popularized and applied in primary hospitals.