Tinelli Andrea, Malvasi Antonio, Guido Marcello, Tsin Daniel Alberto, Hudelist Gernot, Stark Michael, Mettler Liselotte
Department of Obstetrics and Gynecology, Vito Fazzi Hospital, Lecce, Italy.
Surg Innov. 2011 Sep;18(3):201-5. doi: 10.1177/1553350610393989. Epub 2011 Jan 18.
The background of this investigation is based on a common surgical problem: The access in laparoscopic surgery is more difficult in women with previous abdominopelvic surgery, since adhesions and viscera could be close to the point of trocar insertion.
The authors analyzed the safety and the efficacy of a modified direct optical entry (DOE) method versus the Hasson's method by open laparoscopy (OL) in women with previous abdominopelvic surgery in a preliminary prospective case-control study.
A total of 168 women underwent laparoscopic surgery in university-affiliated hospitals: 86 were assigned to abdominal DOE (group A) and 82 to OL (group B). The main outcome measures were statistically compared: time required for entry into abdomen, blood loss, and occurrence of vascular and/or bowel injury. All patients had an intraperitoneal view of the primary port site during surgical procedure.
Statistical differences, in favor of the DOE group (P < .01), were found in duration of entry and blood loss. The vascular and bowel injuries in OL versus DOE were not statistically different.
Obtaining access to the peritoneal cavity in laparoscopic surgery is more difficult in patients with previous abdominopelvic surgery, since it can become a difficult, time-consuming, and occasionally hazardous procedure. The study results suggest that DOE is advantageous when compared with OL in terms of saving time enabling a safe and expeditious visually guided entry for laparoscopy.
本研究基于一个常见的外科问题：既往有腹盆腔手术史的女性在腹腔镜手术中更难建立手术入路，因为粘连和脏器可能靠近套管针穿刺点。
在一项初步的前瞻性病例对照研究中，作者分析了改良直接光学入路（DOE）方法与开放式腹腔镜手术（OL）的哈森方法在既往有腹盆腔手术史的女性中的安全性和有效性。
共有168名女性在大学附属医院接受了腹腔镜手术：86名被分配至腹部DOE组（A组），82名被分配至OL组（B组）。对主要观察指标进行统计学比较：进入腹腔所需时间、失血量以及血管和/或肠道损伤的发生率。所有患者在手术过程中均能看到主穿刺孔部位的腹腔内情况。
在进入时间和失血量方面发现了有利于DOE组的统计学差异（P <.01）。OL组与DOE组的血管和肠道损伤在统计学上无差异。
既往有腹盆腔手术史的患者在腹腔镜手术中建立进入腹腔的入路更为困难，因为这可能成为一个困难、耗时且偶尔有风险的操作。研究结果表明，与OL相比，DOE在节省时间方面具有优势，能够实现安全、快速的腹腔镜视觉引导入路。
