Melzer A, Kipfmüller K, Groenemeyer D, Seibel R, Buess G
Department of Instrument Systems for Image-Guided Therapy and Endoscopic Surgery (INSITE), Institute for Diagnostic and Interventional Radiology, Germany
Semin Laparosc Surg. 1995 Sep;2(3):179-204. doi: 10.1053/SLAS00200179.
One of the keys to safe laparo-endoscopic surgery is an expeditious, reliable, and safe access to the operative field. Aside from appropriate surgical technique, the technology of trocars, cannulae, and other endoscopically guided insertion techniques plays a decisive role for safe identification of and access to the peritoneal cavity. This report takes a close look at critical features of trocar and cannula design for blind insertion with the focus on the biomechanical principles involved in traversing the abdominal wall. Particular attention has been paid to techniques minimizing the risk of accidental injury to major vessels, intestine, and other important structures. The principle of controlled visualized access led to several developments in the field of trocars, cannulae, and puncture techniques. Aside from blind and open access with the Veress needle, conventional trocars and cannulae, a selected variety of endoscopically assisted ports such as the optical Veress needle, optical trocars and optical scalpel, and a vacuum-supported access system are described in detail.
安全的腹腔镜手术的关键之一是快速、可靠且安全地进入手术区域。除了适当的手术技术外，套管针、套管及其他内镜引导插入技术对于安全识别和进入腹膜腔起着决定性作用。本报告深入探讨了用于盲目插入的套管针和套管设计的关键特征，重点关注穿越腹壁所涉及的生物力学原理。特别关注了将意外损伤主要血管、肠道及其他重要结构的风险降至最低的技术。可控可视化进入原则推动了套管针、套管及穿刺技术领域的多项发展。除了使用韦雷氏针进行盲目和开放进入、传统的套管针和套管外，还详细描述了多种内镜辅助端口，如光学韦雷氏针、光学套管针和光学手术刀，以及真空支持进入系统。
