Clinic for General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Hochstraße 29, 14770, Brandenburg an der Havel, Germany.
Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany.
Surg Endosc. 2022 Dec;36(12):9179-9185. doi: 10.1007/s00464-022-09401-9. Epub 2022 Jul 18.
Trocar insertion during laparoscopy may lead to complications such as bleeding, bowel puncture and fascial defects with subsequent trocar site hernias. It is under discussion whether there is a difference in the extent of the trauma and thus in the size of the fascia defect between blunt and sharp trocars. But the level of evidence is low. Hence, we performed a Porcine Model.
A total of five euthanized female pigs were operated on. The average weight of the animals was 37.85 (Standard deviation SD 1.68) kg. All pigs were aged 90 ± 5 days. In alternating order five different conical 12-mm trocars (3 × bladeless, 2 × bladed) on each side 4 cm lateral of the mammary ridge were placed. One surgeon performed the insertions after conducting a pneumoperitoneum with 12 mmHg using a Verres' needle. The trocars were removed after 60 min. Subsequently, photo imaging took place. Using the GSA Image Analyser (v3.9.6) the respective abdominal wall defect size was measured.
The mean fascial defect size was 58.3 (SD 20.2) mm. Bladed and bladeless trocars did not significant differ in terms of caused fascial defect size [bladed, 56.6 (SD 20) mm vs. bladeless, 59.5 (SD 20.6) mm, p = 0.7]. Without significance the insertion of bladeless trocars led to the largest (Kii Fios™ First entry, APPLIEDMEDICAL©, 69.3 mm) and smallest defect size (VersaOne™ (COVIDIEN©, 54.1 mm).
Bladed and bladeless conical 12-mm trocars do not differ in terms of caused fascial defect size in the Porcine Model at hand. The occurrence of a trocar site hernia might be largely independent from trocar design.
腹腔镜下套管插入可能导致出血、肠穿孔和筋膜缺损等并发症，随后出现套管部位疝。目前正在讨论钝性和锐性套管之间创伤程度是否存在差异，从而导致筋膜缺损的大小不同。但是证据水平较低。因此，我们进行了猪模型研究。
总共对 5 头安乐死的雌性猪进行了手术。动物的平均体重为 37.85（标准差 SD 1.68）kg。所有猪的年龄均为 90±5 天。在交替的顺序下，在乳腺嵴外侧 4cm 处的每侧放置 5 个不同的圆锥形 12mm 套管（3×无刃，2×有刃）。一位外科医生在使用 Verres 针进行 12mmHg 的气腹后进行插入。60 分钟后取出套管。随后进行了影像学检查。使用 GSA 图像分析器（v3.9.6）测量相应的腹壁缺损大小。
筋膜缺损的平均大小为 58.3（SD 20.2）mm。有刃和无刃套管在引起的筋膜缺损大小方面没有显著差异[有刃，56.6（SD 20）mm 与无刃，59.5（SD 20.6）mm，p=0.7]。无刃套管的插入导致最大（Kii Fios™ First entry，APPLIEDMEDICAL©，69.3mm）和最小的缺陷尺寸（VersaOne™（COVIDIEN©，54.1mm）。
在当前的猪模型中，有刃和无刃的圆锥形 12mm 套管在引起的筋膜缺损大小方面没有差异。套管部位疝的发生可能在很大程度上与套管设计无关。
