Abd Ellatif Mohamed E, Ghnnam Wagih M, Abbas Ashraf, Basheer Magdy, Dawoud Ibrahim, Ellaithy Ramadan
Department of Surgery, Mansoura University Hospital, Mansoura, Egypt.
Department of Surgery, Hafr Albatin Central Hospital, Hafr Albatin, Saudi Arabia.
Asian J Endosc Surg. 2018 May;11(2):133-137. doi: 10.1111/ases.12418. Epub 2017 Aug 30.
Creating pneumoperitoneum is the most challenging step during laparoscopy. The periumbilical area is the classic site for Veress needle insertion. We adopted a new access point for peritoneal insufflation.
We introduced a new point for Veress needle insertion to create pneumoperitoneum during difficult laparoscopic procedures. The needle is placed between the xiphoid process and the right costal margin, and it then proceeds toward the patient's right axilla. We collected data to compare using this new method of peritoneal insufflation with using Palmer's point for pneumoperitoneum.
Since 2013, we have used this new technique in 570 patients (first group) and Palmer's point in 459 patients (second group). Among these patients, 196 patients (20%) had had previous abdominal operations, 98 patients (10%) had irreducible ventral hernia, and 735 patients (70%) were morbidly obese. The two groups were comparable in terms of patient characteristics. The mean time to create pneumoperitoneum in the first group was 0.8 ± 0.002 min compared to 1.08 ± 0.007 min in the second group (P ≤ 0.5). The mean number of punctures was 1.57 ± 1.02 in the first group compared to 2.9 ± 1.5 in the second group (P≤ 0.5); in the first group, 97% were successful on the first attempt entry, whereas this figure was 91% in second group. In the first group, the liver was punctured in 13 patients without any further complications; no other viscera were punctured. In the second group, gastric puncture occurred in 5 cases, transverse colon in 2 cases, and omental injury in 12 cases.
This new access point may represent a safe, fast, and easy way to create pneumoperitoneum, as well as a promising alternative to Palmer's point in patients who are not candidates for classic midline entry.
建立气腹是腹腔镜手术中最具挑战性的步骤。脐周区域是Veress针穿刺的经典部位。我们采用了一种新的腹膜充气接入点。
在困难的腹腔镜手术中，我们引入了一个新的Veress针穿刺点来建立气腹。将针置于剑突与右肋缘之间，然后朝向患者右腋窝方向进针。我们收集数据，比较使用这种新的腹膜充气方法与使用Palmer点建立气腹的情况。
自2013年以来，我们在570例患者（第一组）中使用了这种新技术，在459例患者（第二组）中使用了Palmer点。在这些患者中，196例（20%）曾接受过腹部手术，98例（10%）有不可复性腹疝，735例（70%）为病态肥胖。两组患者的特征具有可比性。第一组建立气腹的平均时间为0.8±0.002分钟，而第二组为1.08±0.007分钟（P≤0.5）。第一组的平均穿刺次数为1.57±1.02次，第二组为2.9±1.5次（P≤0.5）；第一组97%在首次穿刺时成功进入，而第二组为91%。在第一组中，有13例患者肝脏被穿刺，但无其他并发症；未穿刺其他内脏。在第二组中，发生胃穿刺5例，横结肠穿刺2例，网膜损伤12例。
这种新的接入点可能是一种安全、快速且简便的建立气腹的方法，对于不适合经典中线入路的患者而言，也是一种有前景的替代Palmer点的方法。
