Fanning James, Shah Manish, Fenton Bradford
Department of Obstetrics and Gynecology, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA 17033, USA.
JSLS. 2011 Jan-Mar;15(1):59-61. doi: 10.4293/108680811X13022985131219.
Trocar insertion injury has a high morbidity, mortality, and cost. The purpose of this study was to compare standard trocar entry with our reduced-force closed trocar entry technique by measuring trocar insertion force using a mechanical force gauge.
In the operating room, the force gauge was inserted into a sterile glove and connected to the proximal portion of the trocar to measure insertion force. Through one incision, we used a standard closed trocar entry, while through the other incision, we used our reduced-force closed trocar entry technique. After making the skin incision and before trocar entry, we spread and dilated the skin, subcutaneous tissue, fascia, and muscle with a hemostat.
Twenty-five patients entered the trial and none were excluded. Median trocar insertion force was 3.3lb (range, 1.6 to 5.4) with our reduced-force trocar entry technique versus 6.5lb (range, 2.0 to 14.0) with the standard trocar entry (P=.001). No complications occurred with the reduced-force trocar entry technique.
Our reduced-force trocar entry technique decreases trocar insertion force by 50%, requires no additional instruments or cost and is fast and safe. Reduced-entry force pressure may decrease the risk of trocar insertion injury.
套管针穿刺损伤具有较高的发病率、死亡率及成本。本研究的目的是通过使用机械测力计测量套管针穿刺力，比较标准套管针穿刺与我们的减力闭合套管针穿刺技术。
在手术室中，将测力计插入无菌手套并连接到套管针近端以测量穿刺力。通过一个切口，我们采用标准闭合套管针穿刺，而通过另一个切口，我们采用我们的减力闭合套管针穿刺技术。在切开皮肤后且在套管针穿刺前，我们用止血钳撑开并扩张皮肤、皮下组织、筋膜和肌肉。
25例患者进入试验，无患者被排除。我们的减力套管针穿刺技术的套管针穿刺力中位数为3.3磅（范围为1.6至5.4），而标准套管针穿刺为6.5磅（范围为2.0至14.0）（P = 0.001）。减力套管针穿刺技术未发生并发症。
我们的减力套管针穿刺技术可使套管针穿刺力降低50%，无需额外器械或成本，且快速安全。穿刺力降低可能会降低套管针穿刺损伤的风险。
