Minimally invasive surgery is much safer than traditional open surgery, but the risk of surgery is still an unavoidable style. One of the risk factors is puncture,veress needle puncture and the first trocar puncture are the most dangerous. Half of the complications associated with laparoscopy surgery are related to puncture. Although intestinal injury or large vessel injury caused by puncture is not common, it is still a life-threatening complication.All of this is often overwhelming for the new doctor who just entered the line. Let's introduce the regular four puncture methods to help you summarize the points in 30 seconds. I hope you can gain additional experience to upgrade.
Direct view with a laparoscope
After the skin is cut at the site of the first puncture device, the laparoscope is inserted into
After the skin is cut at the site of the first puncture device, the laparoscope is inserted into a optical trocar, and the incision of each layer of the abdominal wall can be observed under the microscope, thereby ensuring the safety of the operation.
Difficulty factor: ★
Veress needle first
This method is also known as the classic puncture mode. Use a veress needle to establish pneumoperitoneum (general condition is through the umbilicus into the abdomen), and then enter the first trocar after the pneumoperitoneum is formed.
However, the disadvantage is that "blind puncture" can cause damage to the retroperitoneal blood vessels, the abdominal wall blood vessels, and the gastrointestinal tract.
Difficulty factor: ★★
First cut the umbilical tissue into the abdominal cavity, then insert a hasson trocar, and then form a pneumoperitoneum. The disadvantage is that it is time consuming, and if the incision is too large, there is a possibility of air leakage. It is suitable for high-risk patients with a history of abdominal surgery or suspected abdominal adhesions. It can also be used for laparoscopic surgery during pregnancy.
Difficulty factor: ★★★
The pneumoperitoneum is not inserted first, and the trocar is directly inserted. The technical requirements are higher only for an experienced surgeon.
The puncturing device should be 90° with the abdominal wall. After the fascia has passed, the peritoneal layer should be adjusted to be 45° with the horizontal plane, and slowly enter the abdominal cavity.
Difficulty factor: ★★★★
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