Department of General Surgery, University of Toronto, Toronto, Ont.
Can J Surg. 2011 Oct;54(5):315-20. doi: 10.1503/cjs.011210.
Laparoscopic surgery has gained popularity over open conventional surgery as it offers benefits to both patients and health care practitioners. Although the overall risk of complications during laparoscopic surgery is recognized to be lower than during laparotomy, inadvertent serious complications still occur. Creation of the pneumoperitoneum and placement of laparoscopic ports remain a critical first step during endoscopic surgery. It is estimated that up to 50% of laparoscopic complications are entry-related, and most injury-related litigations are trocar-related. We sought to evaluate the current practice of laparoscopic entry among Canadian general surgeons.
We conducted a national survey to identify general surgeon preferences for laparoscopic entry. Specifically, we sought to survey surgeons using the membership database from the Canadian Association of General Surgeons (CAGS) with regards to entry methods, access instruments, port insertion sites and patient safety profiles. Laparoscopic cholecystectomy was used as a representative general surgical procedure.
The survey was completed by 248 of 1000 (24.8%) registered members of CAGS. Respondents included both community and academic surgeons, with and without formal laparoscopic fellowship training. The demographic profile of respondents was consistent nationally. A substantial proportion of general surgeons (> 80%) prefer the open primary entry technique, use the Hasson trocar and cannula and favour the periumbilical port site, irrespective of patient weight or history of peritoneal adhesions. One-third of surgeons surveyed use Veress needle insufflation in their surgical practices. More than 50% of respondents witnessed complications related to primary laparoscopic trocar insertion.
General surgeons in Canada use the open primary entry technique, with the Hasson trocar and cannula applied periumbilically to establish a pneumoperitoneum for laparoscopic surgery. This surgical approach is remarkably consistent nationally, although considerably variant across other surgical subspecialties. Peritoneal entry remains an important patient safety issue that requires ongoing evaluation and study to ensure translation into safe contemporary clinical practice.
腹腔镜手术因其对患者和医疗保健从业者都有益处，已在传统开腹手术中流行起来。虽然腹腔镜手术的总体并发症风险被认为低于开腹手术，但仍会发生意外的严重并发症。在内镜手术中，创建气腹和放置腹腔镜端口仍然是至关重要的第一步。据估计，高达 50%的腹腔镜并发症与入路相关，大多数与损伤相关的诉讼都与 trocar 有关。我们试图评估加拿大普通外科医生目前的腹腔镜入路实践。
我们进行了一项全国性调查，以确定普通外科医生对腹腔镜入路的偏好。具体来说，我们试图通过加拿大普通外科医生协会 (CAGS) 的会员数据库，就入路方法、入路器械、端口插入部位和患者安全概况对外科医生进行调查。腹腔镜胆囊切除术被用作一般外科手术的代表。
该调查由 CAGS 的 1000 名注册会员中的 248 名（24.8%）完成。受访者包括社区和学术外科医生，以及是否具有正规的腹腔镜研究员培训。受访者的人口统计学概况在全国范围内是一致的。相当一部分普通外科医生（>80%）更喜欢开放式主要入路技术，使用 Hasson 套管针，并倾向于脐周端口部位，无论患者体重或腹膜粘连史如何。三分之一的调查外科医生在他们的手术实践中使用 Veress 针进行充气。超过 50%的受访者目睹了与主要腹腔镜 trocar 插入相关的并发症。
加拿大的普通外科医生使用开放式主要入路技术，采用 Hasson 套管针经脐周建立气腹进行腹腔镜手术。这种手术方法在全国范围内非常一致，尽管在其他外科亚专业中差异很大。腹膜入路仍然是一个重要的患者安全问题，需要不断评估和研究，以确保转化为安全的当代临床实践。
