Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan (Drs. Nishimura, Matsumoto, Ohara, Minowa, Tsunematsu, Takimoto, Imai, Tsuzuki, Ota, Nakajima, Fukushi, Wada, and Fujino).
Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan (Drs. Nishimura, Matsumoto, Ohara, Minowa, Tsunematsu, Takimoto, Imai, Tsuzuki, Ota, Nakajima, Fukushi, Wada, and Fujino).
J Minim Invasive Gynecol. 2019 Jan;26(1):63-70. doi: 10.1016/j.jmig.2018.06.023. Epub 2018 Oct 21.
This systematic review aimed to investigate complications related to initial trocar insertion among 3 different laparoscopic techniques: Veress needle (VN) entry, direct trocar entry (DTE), and open entry (OE). A literature search was completed, and complications were assessed. Major vessel injury, gastrointestinal injury, and solid organ injury were defined as major complications. Minor complications were defined as subcutaneous emphysema, extraperitoneal insufflation, omental emphysema, trocar site bleeding, and trocar site infection. Arm-based network meta-analyses were performed to identify the differences in complications among the 3 techniques. Seventeen studies were included in the quantitative analysis. DTE resulted in fewer major complications when compared with VN entry although the difference was not significant (p = .23) as well as significantly fewer minor complications (p < .001). There were no significant differences in minor complications when comparing OE and DTE (p = .74). Fewer major complications were observed with OE compared with VN entry although the difference was not significant (p = .31). There were significantly fewer minor complications for patients who underwent OE (p = .01). DTE patients experienced the least number of minor complications followed by VN entry and OE. In conclusion, major complications are extremely rare, and all 3 insertion methods can be performed without mortality.
本系统评价旨在调查 3 种不同腹腔镜技术（Veress 针（VN）入路、直接套管针入路（DTE）和开放式入路（OE））中与初始套管针插入相关的并发症。进行了文献检索，并评估了并发症。主要血管损伤、胃肠道损伤和实质脏器损伤被定义为主要并发症。次要并发症定义为皮下气肿、腹膜外充气、大网膜气肿、套管针部位出血和套管针部位感染。采用基于手臂的网络荟萃分析来确定 3 种技术之间并发症的差异。17 项研究纳入了定量分析。与 VN 入路相比，DTE 导致的主要并发症较少，尽管差异无统计学意义（p = .23），且次要并发症明显减少（p <.001）。OE 与 DTE 相比，次要并发症无显著差异（p = .74）。与 VN 入路相比，OE 观察到的主要并发症较少，尽管差异无统计学意义（p = .31）。OE 患者的次要并发症明显减少（p = .01）。DTE 患者的次要并发症最少，其次是 VN 入路和 OE。总之，严重并发症极为罕见，所有 3 种插入方法都可以在无死亡率的情况下进行。
