Marchand Greg J, Masoud Ahmed, King Alexa, Brazil Giovanna, Ulibarri Hollie, Parise Julia, Arroyo Amanda, Coriell Catherine, Goetz Sydnee, Moir Carmen, Christensen Ashley, Alexander Tia, Govindan Malini
Marchand Institute for Minimally Invasive Surgery, Mesa, Arizona, USA.
Fayoum University Faculty of Medicine, Fayoum, Egypt.
BMJ Surg Interv Health Technol. 2022 Jun 28;4(1):e000121. doi: 10.1136/bmjsit-2021-000121. eCollection 2022.
Although many studies have been performed, no consensus exists as to the ideal entry for laparoscopic gynecologic surgery. We sought out to compare the safety of direct trocar insertion with that of the Veress needle entry technique in gynecologic laparoscopic surgery.
Systematic review with meta-analysis.
We searched Medline, ClinicalTrials.Gov, PubMed, Cochrane CENTRAL, SCOPUS, and Web of Science from their inception through 31 July 2021 for relevant studies. We included only controlled trials and ultimately seven trials were included in our meta-analysis.
Inclusion criteria included women undergoing gynecological laparoscopic surgery.
The intervention of direct trocar insertion technique compared with Veress needle entry technique.
We compared five different outcomes associated with the efficacy and complications of laparoscopic entry.
The pooled analysis showed that Veress needle entry was associated with a significant increase in the incidences of extraperitoneal insufflation (RR=0.177, 95% Cl (0.094 to 0.333), p<0.001), omental injury (RR=0.418, 95% Cl (0.195 to 0.896), p<0.001), failed entry (RR=0.173, 95% Cl (0.102 to 0.292), p<0.001), and trocar site infection (RR=0.404, 95% Cl (0.180 to 0.909), p<0.029). There was no significant difference between the two groups regarding the visceral injury (RR=0.562, 95% Cl (0.047 to 6.676), p<0.648).
When excluding all data apart from gynecologic surgery, the Veress needle entry technique may have an increased incidence of some, but not all complications of laparoscopic entry. It may also have a higher incidence of failed entry compared with direct entry techniques. Care should be taken in extrapolating these general results to specific surgeon experience levels.
CRD42021273726.
尽管已经开展了许多研究，但对于腹腔镜妇科手术的理想入路尚未达成共识。我们旨在比较妇科腹腔镜手术中直接套管针插入与韦氏针穿刺技术的安全性。
系统评价与荟萃分析。
我们检索了Medline、ClinicalTrials.Gov、PubMed、Cochrane CENTRAL、SCOPUS和Web of Science自创建至2021年7月31日的相关研究。我们仅纳入对照试验，最终7项试验纳入我们的荟萃分析。
纳入标准包括接受妇科腹腔镜手术的女性。
将直接套管针插入技术与韦氏针穿刺技术进行干预比较。
我们比较了与腹腔镜入路的有效性和并发症相关的五种不同结果。
汇总分析显示，韦氏针穿刺与腹膜外充气发生率显著增加相关（风险比=0.177，95%可信区间（0.094至0.333），p<0.001）、网膜损伤（风险比=0.418，95%可信区间（0.195至0.896），p<0.001）、穿刺失败（风险比=0.173，95%可信区间（0.102至0.292），p<0.001）和套管针穿刺部位感染（风险比=0.404，95%可信区间（0.180至0.909），p<0.029）。两组在内脏损伤方面无显著差异（风险比=0.562，95%可信区间（0.047至6.676），p<0.648）。
在排除妇科手术以外的所有数据时，韦氏针穿刺技术可能会增加某些但并非所有腹腔镜入路并发症的发生率。与直接穿刺技术相比，其穿刺失败的发生率可能也更高。在将这些一般结果外推至特定外科医生经验水平时应谨慎。
CRD42021273726。
