Moreno Danilo Galante, Pereira Cesar Augusto Martins, Sant Anna Ricardo Kyoiti, de Azevedo Rafael Ulysses, Savio Luiz Felipe, Duarte Ricardo Jordão, Srougi Miguel, Passerotti Carlo Camargo
Laboratory of Medical Research, Department of Urology, University of Sao Paulo, São Paulo, Brazil.
Center for Robotic Surgery, Oswaldo Cruz German Hospital, São Paulo, Brazil.
JSLS. 2019 Apr-Jun;23(2). doi: 10.4293/JSLS.2019.00002.
The number of laparoscopic procedures increases annually with an estimated 3% of complications, one third of them linked to Verres' needle or trocar insertion. The safety and efficacy of ports insertion during laparoscopic surgery may be related the technique but also to trocar design. This study aims to compare physical parameters of abdominal wall penetration for 5 different trocars.
Eleven pigs were studied. Five different commercially available trocars were randomically inserted at the midline. Real-time video recording of the insertions was achieved to measure the excursion of the abdominal wall and the time and distance the cutting surface of the bladed trocars was exposed inside the abdominal cavity. An especially designed hand sensor was developed and placed between the trocar and the hand of the surgeon to record force required for abdominal wall perforation.
Greater deformations and forces occurred in nonbladed as compared to bladed trocars, and in conical trocars as compared to pyramidal pointed ones, except for peritoneum perforation. Greater distance and time of blade exposure occurred in pyramidal laminae as compared to conical.
The bladed trocars have lower forces and deformations in their introduction, and should be those that cause less injury and are more suitable for first entry. Conical and pyramidal trocars with the same blade size showed similar force, deformation, time, and distance of exposed blade.
腹腔镜手术的数量逐年增加，并发症发生率估计为3%，其中三分之一与Verres针或套管针插入有关。腹腔镜手术中套管针插入的安全性和有效性可能与技术有关，但也与套管针设计有关。本研究旨在比较5种不同套管针对腹壁穿透的物理参数。
对11头猪进行研究。将5种不同的市售套管针随机插入中线处。对插入过程进行实时视频记录，以测量腹壁的偏移以及带刀片套管针的切割面在腹腔内暴露的时间和距离。开发了一种专门设计的手部传感器，并放置在套管针和外科医生的手之间，以记录腹壁穿孔所需的力。
与带刀片的套管针相比，无刀片的套管针以及与锥形尖端的套管针相比，圆锥形套管针在除腹膜穿孔外的情况下会产生更大的变形和力。与圆锥形相比，金字塔形叶片的刀片暴露距离和时间更长。
带刀片的套管针在插入时产生的力和变形较小，应该是造成损伤较小且更适合首次进入的套管针。具有相同刀片尺寸的圆锥形和金字塔形套管针在力、变形、时间和刀片暴露距离方面表现相似。
