Department of Surgery, Maulana Azad Medical College, New Delhi, 110002, India.
Surg Endosc. 2012 Jan;26(1):182-8. doi: 10.1007/s00464-011-1852-5. Epub 2011 Aug 19.
The open technique for the placement of the first trocar in laparoscopic surgery has become the preferred method due to the reduced number of complications associated with it. In 2002 we reported our technique, which has been widely accepted at many centers, including all the units of our hospital. We now report on a series of 6,000 cases in which this technique was used.
The method is the same as that reported by us previously (Surg Endosc 16:1366-1370, [10]) except for the minor modification of using a Mayo towel clip instead of the Allis forceps for holding the cicatrix pillar, as the pillar tends not to slip out of the former. During closure, Allis forceps is used to lift the divided rectus sheath on each side to take the suture bite and ensure complete secure closure. A total of 6,000 consecutive cases have been performed using this technique in two tertiary care hospitals over the last 11 years.
A total of 6,000 cases (5,350 females and 650 males) were operated on over an 11-year period. There were no visceral or vascular complications. Four hundred seventy-five patients (7.9%) had had previous abdominal surgery. The supraumbilical route was used in 348 patients and lateral entry in 90 patients. Port-site hernias were seen in 25 cases (0.4%) and wound infections in 56 cases (0.9%). The average time for trocar placement was 2 min (range = 1-12 min) and the average port size was 15 mm (range = 12-22 mm). The average time for port closure at the end of the procedure was 3 min (range = 1-7 min).
The technique of open-trocar placement in laparoscopic surgery has now become standardized, with its safety having been well established. Our experience has shown that this technique is safe, effective, reproducible, easy to learn, can be performed quickly, and has excellent results.
由于与开放技术相关的并发症较少，腹腔镜手术中第一套管针的开放入路已成为首选方法。2002 年，我们报道了我们的技术，该技术已被包括我院所有单位在内的许多中心广泛接受。我们现在报告了在 6000 例病例中使用该技术的情况。
该方法与我们之前报道的方法相同（Surg Endosc 16:1366-1370，[10]），除了用 Mayo 巾夹代替 Allis 钳子来夹持疤痕柱这一微小的修改，因为柱子不容易从前者滑出。在关闭时，使用 Allis 钳子提起两侧的分开的腹直肌鞘，以进行缝合咬口，并确保完全牢固地关闭。在过去 11 年的两家三级护理医院中，使用这种技术共进行了 6000 例连续病例。
在 11 年期间，共对 6000 例（5350 名女性和 650 名男性）进行了手术。没有内脏或血管并发症。475 例（7.9%）患者曾有过腹部手术史。脐上入路在 348 例患者中使用，外侧入路在 90 例患者中使用。在 25 例（0.4%）患者中发现切口疝，56 例（0.9%）患者发生切口感染。套管针放置的平均时间为 2 分钟（范围= 1-12 分钟），平均套管针大小为 15 毫米（范围= 12-22 毫米）。在手术结束时，套管针的平均关闭时间为 3 分钟（范围= 1-7 分钟）。
腹腔镜手术中开放套管针放置的技术现已标准化，其安全性已得到充分证实。我们的经验表明，该技术安全、有效、可重复、易于学习、操作迅速，且效果极佳。
