Tinelli Andrea, Malvasi Antonio, Hudelist Gernot, Istre Olav, Keckstein Joerg
Department of Obstetrics and Gynecology, Vito Fazzi Hospital, Piazza Muratore, Lecce, Italy.
J Laparoendosc Adv Surg Tech A. 2009 Aug;19(4):529-33. doi: 10.1089/lap.2008.0322.
More than 50% of major laparoscopic complications occur during the initial entry into the abdomen. We investigated the efficacy and the safety of two laparoscopic access techniques: the direct optical access (DOA) versus the classical open entry, as described by Hasson.
Two hundred and two premenopausal women, homogeneous in age, parity, and body mass index undergoing laparoscopic surgery for simple ovarian cysts, were prospectively, randomly assigned to either open or DOA abdominal entry for laparoscopic surgery. The following parameters were compared: duration of access for entry into the abdomen, occurrence of vascular and/or bowel injury, and blood loss. The results were analyzed by using SAS software (SAS Institute, Inc., Cary, NC), considering a P-value of <0.05 as significant.
No statistically significant differences were observed in the occurrence of major vascular and/or bowel injury between the two techniques. However, time for establishment of abdominal entry was significantly reduced in the DOA group, as was the blood loss (P < 0.05).
The results of this preliminary comparison on the DOA and the Hasson methods, commonly used by general surgeons and less frequently by gynecologists, suggest that the visual entry system confers a little statistical advantage over the traditional Hasson entry, in terms of safety, minimal time saving, and in reducing blood loss, allowing a safe, fast, visually guided entry.
超过50%的腹腔镜手术严重并发症发生在初次进入腹腔时。我们研究了两种腹腔镜进入技术的有效性和安全性：直接光学进入法（DOA）与哈森描述的传统开放进入法。
202例因单纯性卵巢囊肿接受腹腔镜手术的绝经前女性，在年龄、产次和体重指数方面具有同质性，被前瞻性、随机分配接受腹腔镜手术的开放或DOA腹部进入法。比较了以下参数：进入腹腔的时间、血管和/或肠道损伤的发生率以及失血量。使用SAS软件（SAS Institute，Inc.，北卡罗来纳州卡里）分析结果，将P值<0.05视为具有统计学意义。
两种技术在主要血管和/或肠道损伤的发生率上未观察到统计学显著差异。然而，DOA组建立腹部进入的时间显著缩短，失血量也显著减少（P<0.05）。
对普通外科医生常用而妇科医生较少使用的DOA法和哈森法进行的这一初步比较结果表明，在安全性、节省最少时间和减少失血量方面，视觉进入系统相对于传统的哈森进入法具有一定的统计学优势，可实现安全、快速、视觉引导的进入。
