Single Incision Laparoscopic Surgery with Conventional Instruments (original) (raw)
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Basŕah Journal of Surgery, 2016
The creation of pneumoperitoneum is an essential step in laparoscopy, Veress needle, direct trocar entrance and modified open methods with their different modifications are the three widely used methods nowadays. Each method has its own advantages & disadvantages and each surgeon has his own preferred method of creating pneumoperitoneum based on his training and experience. The aim is to compare the safety and efficacy of modified open insertion technique (MOIT) with the direct trocar insertion (DTI) and Veress needle techniques (VN). From January 2013 to December 2015, two hundred ten patients with different indications for laparoscopic surgery were included in this study for evaluation of three different methods of creating pneumoperitoneum, one hundred forty of them were operated upon in Al-Sadir teaching hospital by same laparoscopic surgeon with closed technique, this group was equally divided in to two groups; Veress needle technique (VN group) and direct trocar insertion technique (DTI group) each group included 70 patients, the remaining seventy patients were operated upon in Al Shiffa general hospital by same laparoscopic surgeons with modified open trocar insertion technique (MOTI group). Of the 210 patients; 70 (33.33%) patients operated with Veress needle (VN) technique in patients, 70 (33.33%) patients operated with Direct trocar insertion (DTI) technique and 70 (33.33%) patients operated with Modified open trocar insertion (MOTI), the patient’s ages ranged from 17 to 76 years, 172 (82%) patients were females and 38 (18%) patients were males. The mean time required for entry in patients subjected to VN technique was 3.63±0.64 minutes in comparison to 1.79±2.39 minutes and 2.01±1.82 minutes for (DTI) and (MOTI) techniques respectively, this difference is statistically significant (p-value <0.001), the VN technique associated with high rate of minor complications 32 (45.71%) patients in comparison with 7 (10%) patients and 5 (7.14%) patients reported during DTI and MOTI respectively, this difference is statistically significant (p-value <0.001), there were no reported major complication in this study like visceral or vascular injury and gas embolism. In conclusion, both DTI and MOTI techniques are safe and effective procedures to create pneumoperitoneum during laparoscopic surgery, they are associated with few minor complications and no failer rate in comparison to VN technique.
Comparative study of direct trocar entry versus Veress needle entry for laparoscopic surgery
International Journal of Surgery Science, 2021
Introduction: Laparoscopy has revolutionised Surgery with its widespread acceptance as predominantly minimally invasive to intraabdominal surgical procedures. Laparoscopy is the art of examining the abdominal cavity and its contents. It requires insertion of a cannula through the abdominal wall, distention of the abdominal cavity with gas or air (pneumoperitoneum), and visualization and examination of the abdomen's contents with an illuminated telescope. Material and Methods: This is a prospective and observational study conducted in the Department of General Surgery at Prathima Institute of Medical Sciences over a period of 1 year. All the cases who underwent laparoscopic tubal ligation procedure during this time were taken into account. The traditional technique of Veress Needle entry (Group A) and Direct trocar entry (Group B). Inclusion Criteria: Patients which are posted for planned laproscopic surgeries irrespective of age and sex. Exclusion Criteria: Emergency surgeries. ▪ Patients having abdominal scars crossing umbilicus. ▪ Immunocompromised patients ▪ Seropositive patients. Result: In our present study, a total of 90 patients were included in both the groups out of which 21 (23.4%) were males and 69 (76.6%) were females in Group A and in Group B: 19 (21.1%) were males and 71 (78.9%) were females. The mean time taken to create Pneumoperitoneum in case of Veress Needle entry was 4 min 01 sec, of which maximum was 7 min 10 sec and minimum was only 3 min 05 sec. The mean time taken to create Pneumoperitoneum in case of Direct trocar entry was 1 min 43 sec, of which maximum was 3 min 20 sec and minimum was 1 min 15 sec. Complications arising during procedures were identified and recorded. Group A patients 6 patients witnessed omental emphysema was commonest complication followed by 5 patients preperitoneal insufflation while as the most common complication in group B was omental emphysema in 2 patients. Conclusion: Direct Trocar entry is a safe alternative to the Veress needle entry technique for the creation of pneumoperitoneum. One of the main advantages of this technique is the reduced number of the blind insertions required to gain abdominal access. Other benefits are rapid creation of pneumoperitoneum, less gas use and decreased operating time. In laparoscopic surgeries, it is a more reliable and less timeconsuming method.
Direct Trocar Insertion for Laparoscopy
JSLS, Journal of the Society of Laparoendoscopic Surgeons, 2012
The Veress needle (VN) technique for establishing pneumoperitoneum in laparoscopic surgery is widely used and yet is associated with slow insufflation rates and potentially life-threatening complications. Although these complications have been rarely reported, they represent a major source of morbidity and mortality from laparoscopic procedures and a major reason for conversion to open surgery. The open laparoscopy (OL) is an alternative to the VN technique, being relatively safer, even if considered cumbersome by many authors. Recently, the direct trocar insertion (DTI) technique of establishing pneumoperitoneum has been reported as an alternative to both techniques, but it is largely confined to gynecologic procedures. We report a case-series study where we evaluate the patients who underwent a DTI entry for laparoscopy during a recent 5-year period, focusing attention on feasibility, safety, and the benefits of DTI.
Laparoscopic Needles and Trocars: An Overview of Designs and Complications
Journal of Laparoendoscopic Surgery, 1992
Although the gynecologist has utilized the laparoscope both diagnostically and therapeutical I y for several decades, laparoscopic surgery has only recently gained great acceptance in the general surgical and urologie community. However, the enthusiasm for this new technology for minimally invasive surgery must be dampened by the small incidence of complications, most of which occur during the creation of the initial pneumoperitoneum and, in particular, during the insertion of the Veress needle and the principal trocar. The purpose of this paper is to review needle and trocar designs, to describe the complications of their use, and to identify factors that may contribute to injury and those that will minimize the risk. NEEDLE DESIGNS Veress needle The veress needle is used to establish the pneumoperitoneum and thus, clearly, is a critical element of a
International Journal of Research in Medical Sciences, 2016
Background: The objective of this study was to compare the safety and efficacy of modified open technique and closed technique for gaining entry [primary trocar insertion] and establishing pneumoperitoneum in laparoscopic surgery. Methods: The present study was prospective, observational and longitudinal. Protocol of the procedure was formed along with Performa, Patient Information Sheet and Informed Consent Form. The present study was carried out in surgery department of C.U Shah medical college, Surendranagar, Gujarat state. The study was carried out from 1st October 2012 till 31st May 2014. A total of two hundred patients undergoing emergency and elective laparoscopic surgery were included in our study. Case records of patients was recorded in the Performa containing demographic details, size and site of trocar insertion, technique of trocar insertion, intraoperative, early postoperative and late post operative complications were noted. Results: Total of 200 cases was included in our study. The age of patients ranges from 10-70 years. Out of 200 cases 90% were females suffering from different ailments and 105 were males in group A while in Group b 80% were females and 20%were males. In terms of on table complications; gastrointestinal injury is more in close method of trocar insertion. Conclusions: We would advocate the modified open technique of trocar insertion as a technique of choice in primary trocar insertion as it is more efficacious and counts more on patient safety as compared to the close technique.
Safe Technique for Laparoscopic Entry into the Abdominal Cavity
The Journal of the American Association of Gynecologic Laparoscopists, 2001
Study Objective. To evaluate and compare the safety and efficacy of a new method to enter the abdominal cavity at laparoscopy. Design. (Canadian Task Force classification II-2). Setting. Referral center for reproductive surgery in a teaching hospital affiliated with a university-based residency program. Patients. Twenty representative women of variable body habitus (body mass index 16.5-39 kg/m 2). Intervention. Laparoscopy and laparotomy. Measurements and Main Results. We measured the thickness of the abdominal wall at the base of the umbilicus and just below its inferior border. We also measured distances traversed by the Veress needle or cannula from skin to peritoneal cavity at both sites when the piercing instrument was directed at 45-or 90-degree angle from the horizontal plane of the abdominal wall. Finally, we measured distances created between parietal peritoneum and underlying viscera when the abdominal wall was lifted manually or with towel clips placed laterally, 2 cm from the umbilicus and at the edges of the intraumbilical incision. Distances created between parietal peritoneum and underlying viscera while lifting the abdominal wall by each of these three techniques were measured with a calibrated probe inserted through the intraumbilical port and observed with a 5-mm laparoscope from the suprapubic port. These distances were measured before and after carbon dioxide insufflation at 15 mm Hg, as well as before and while inserting the cannula through the abdominal wall. Mean ± SD thickness of the abdominal wall at the base of the umbilicus and lower border of the umbilicus were 1.4 ± 0.5 and 3.0 ± 1.1 cm, respectively (p <0.01). Distances traversed by piercing instruments through the abdominal wall at the umbilicus and lower border of the umbilicus when the angle of insertion was 45 degrees were 1.98 ± 0.76 and 4.24 ± 1.53 cm, respectively (p <0.01). Distances were significantly greater when the angle of insertion was 45 degrees rather than 90 degrees. Distances between parietal peritoneum and underlying viscera when the abdominal wall was lifted manually with towel clips 2 cm from the umbilicus, or at the edges of the intraumbilical incision were 3.5 ±1.14, 5.14 ± 1.04, and 6.8 ± 0.94 cm, respectively (p <0.01). When force was applied on the abdomen at cannula insertion, these distances were reduced by 2.1 ± 0.91, 1.03 ± 0.32, and zero centimeters, respectively (p <0.01). Conclusion. Our technique of inserting the cannula perpendicularly through the base of the umbilicus traverses the shortest distance to the abdominal cavity through the least vascular area of the abdominal wall. Lifting the abdominal wall with towel clips placed at the edges of the intraumbilical incision achieves the greatest distance between parietal peritoneum of the abdominal wall and underlying viscera, thus maximizing the margin of safety in protecting peritoneal organs and retroperitoneal vessels from injury.
Current Abdominal Incision for Obstetrics and Gynecologic Surgery
2012
Explore laparotomy in Obstetrics and Gynecology is still the important role in current practice. Several types of abdominal incision have been developed for hundred years. Either transverse or midline incision is often used in obstetrics and gynecologic surgery. Each of incision has different advantage and limitation that should be tailored for each case. This article provides scope on accessibility, extensibility and security of incision. The appropriate abdominal incision and effi cient surgical team yield an excellent result of operation. Key words: Abdominal incision, Obstetrics, Gynecologic surgery