Passerotti Carlo C, Begg Nikolai, Penna Frank J, Passerotti Ana Maria A M S, Leite Katia R M, Antunes Alberto Azoubel, Srougi Miguel, Retik Alan B, Nguyen Hiep T
Robotic Research and Training Center, Department of Urology, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, USA.
J Am Coll Surg. 2009 Aug;209(2):222-32. doi: 10.1016/j.jamcollsurg.2009.03.022. Epub 2009 May 28.
The most common laparoscopic complications are associated with trocar insertion. The purpose of this study was to develop an objective method of evaluating the safety profile of various access devices used in laparoscopic surgery.
In 20 swine, 6 bladed and 2 needle access devices were evaluated. A force profile was determined by measuring the force required to drive the trocar or needle through the fascia and into the peritoneum, at 0 and 10 mmHg. The amount of tissue deformation, the length of blade exposed, and the duration of exposure were measured using a high-speed digital imaging system.
The needle system without the sheath required the least driving force and had the most favorable force profile. In contrast, the bladed, nonretractable trocar system required a higher driving force and a rapid loss of resistance. Insertion under a pneumoperitoneum did not significantly alter the force profile of the various access devices except for the amount of tissue deformation. With the bladed system, the blade itself was exposed for an average of 0.5 to 1.0 seconds for a distance of 4.5 to 5.0 cm. In comparison, the needle system was exposed for 0.2 seconds for a distance of 1.8 cm.
We developed a reproducible method of measuring the forces required to place the access systems, their pattern of resistance loss, and the characteristics of the blade exposure. These parameters may provide an adjunctive and objective measurement of safety, allowing for more direct comparison between various trocar designs.
最常见的腹腔镜并发症与套管针插入有关。本研究的目的是开发一种客观方法，以评估腹腔镜手术中使用的各种进入装置的安全性。
对20头猪评估了6种带刀片和2种针式进入装置。通过测量在0和10 mmHg压力下将套管针或针穿过筋膜并进入腹膜所需的力来确定力分布。使用高速数字成像系统测量组织变形量、刀片暴露长度和暴露持续时间。
不带护套的针式系统所需驱动力最小，力分布最有利。相比之下，带刀片的不可回缩套管针系统需要更高的驱动力且阻力快速丧失。除组织变形量外，气腹下插入并未显著改变各种进入装置的力分布。对于带刀片系统，刀片本身平均暴露0.5至1.0秒，暴露长度为4.5至5.0厘米。相比之下，针式系统暴露0.2秒，暴露长度为1.8厘米。
我们开发了一种可重复的方法，用于测量放置进入系统所需的力、其阻力丧失模式以及刀片暴露特征。这些参数可提供辅助性的客观安全性测量，便于更直接地比较各种套管针设计。
