Department of Obstetrics and Gynecology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Chin Med J (Engl). 2009 Nov 20;122(22):2733-6.
Laparoscopic entry is of primary importance in laparoscopic surgery because of its potential association with serious complications such as visceral and vascular injuries. There are several approaches now available for laparoscopic entry. The present study reported a modified open trocar first-puncture approach (Yan's open technique) and validated its safety and practicability in a multi-center research.
The study was performed in seven gynecological endoscopy centers for 8 successive years from September 1998 to March 2006 involving 17 350 patients, who received the modified open trocar first-puncture approach developed by Dr. LIU Yan as the study group (MOT group). The "Yan's open technique" is the umbilical incision with a scalpel and then a 10-mm trocar entry into the abdominal cavity through direct trocar puncture or insertion of the cannula sheath via the opened umbilicus under no resistance. Another 4570 patients received the traditional Veress needle puncture as the control (VN group). The first puncture procedures of both groups were performed by 28 experienced gynecologic laparoscopists and 170 learners.
In MOT group, the successful achievement rate (AR) of first puncture was 99.99% (17 348/17 350), including smooth manipulation in 17 326 cases and unsmooth manipulation in 22 cases. The remaining two cases failed. First-puncture associated complications occurred in two cases (0.01%). In VN group, the successful AR of first puncture was 99.89% (4565/4570), including smooth manipulation in 4542 cases and unsmooth manipulation in 23 cases. The remaining five cases failed. First-puncture associated complications occurred in four cases (0.09%). There was no significant difference in the successful AR between the experienced gynecologic laparoscopists of the two groups (100% vs 100%, P > 0.05), but the difference was significant between the learners of the two groups (99.98% vs 99.81%, P < 0.05). The complication rate of VN group was significantly higher than that of MOT group (0.09% vs 0.01%, P < 0.05).
Compared with the traditional Veress needle puncture, the modified open trocar first-puncture is easier to follow, especially for learners. In addition, it can avoid possible Veress needle-associated injuries. Opening the umbilical hole for the sake of minimizing or zeroing puncture resistance is a safer and more practicable maneuver for laparoscopic entry.
腹腔镜手术中，腹腔镜进入是首要的，因为它可能与内脏和血管损伤等严重并发症有关。现在有几种腹腔镜进入的方法。本研究报告了一种改良的开放式套管针第一穿刺方法（闫氏开放技术），并在一项多中心研究中验证了其安全性和实用性。
本研究于 1998 年 9 月至 2006 年 3 月在 7 个妇科内镜中心进行，连续 8 年，共纳入 17350 例患者，这些患者接受了由刘岩博士开发的改良开放式套管针第一穿刺方法（MOT 组）。“闫氏开放技术”是指用手术刀进行脐部切口，然后通过直接套管针穿刺或通过无阻力的开放脐部插入套管鞘进入腹腔。另外 4570 例患者接受了传统的 Veress 针穿刺作为对照（VN 组）。两组的第一穿刺程序均由 28 名有经验的妇科腹腔镜医师和 170 名学习者完成。
在 MOT 组中，首次穿刺的成功率（AR）为 99.99%（17348/17350），其中 17326 例操作顺利，22 例操作不顺利。其余两例失败。首次穿刺相关并发症发生在两例（0.01%）。在 VN 组中，首次穿刺的成功率为 99.89%（4565/4570），其中 4542 例操作顺利，23 例操作不顺利。其余五例失败。首次穿刺相关并发症发生在四例（0.09%）。两组有经验的妇科腹腔镜医师的首次穿刺成功率无显著差异（100%比 100%，P>0.05），但两组学习者的差异有统计学意义（99.98%比 99.81%，P<0.05）。VN 组的并发症发生率明显高于 MOT 组（0.09%比 0.01%，P<0.05）。
与传统的 Veress 针穿刺相比，改良的开放式套管针第一穿刺更容易遵循，尤其是对学习者而言。此外，它可以避免可能的 Veress 针相关损伤。为了最大限度地减少或消除穿刺阻力而打开脐孔是一种更安全、更实用的腹腔镜进入方法。
