Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
Surg Endosc. 2023 Jul;37(7):5368-5373. doi: 10.1007/s00464-023-10031-y. Epub 2023 Mar 30.
Injuries during initial port placement in minimally invasive abdominal surgery are rare but can cause major morbidity. We aimed to characterize the incidence, consequence, and risk factors for injury occurring on initial port placement.
This is a retrospective review of a General Surgery quality collaborative database with supplementary input from the Morbidity and Mortality conference database at our institution between 6/25/2018 and 6/30/2022. Patient characteristics, operative details, and postoperative course were assessed. Cases with an injury on entry were compared to cases without an injury to identify risk factors for injury.
8844 minimally invasive cases were present between the two databases. Thirty-four injuries (0.38%) occurred during initial port placement. Seventy-one percent of injuries were bowel injuries (full or partial thickness) and the majority (79%) of injuries were recognized during the index operation. Median surgeon experience for the cases with an injury was 9 years (IQR 4.25-14.5) compared to 12 years of experience for all surgeons contributing to the database (p = 0.004). Previous laparotomy was also significantly correlated with the rate of injury on entry (p = 0.012). There was no significant difference in the rate of injury based on method of entry (cut-down: 19 (55.9%), optical entry without Veress: 10 (29.4%), Veress followed by optical entry: 5 (14.7%), p = 0.11). BMI > 30 kg/m (injury: 16/34 vs no injury: 2538/8844, p = 0.847) was not associated with an injury. Fifty-six percent (19/34) of patients with an injury on initial port placement required laparotomy at some point in their hospital course.
Injuries are rare during initial port placement for minimally invasive abdominal surgery. In our database, history of a previous laparotomy was a significant risk factor for an injury and appears to be more consequential than commonly implicated factors such as technique, patient body habitus, or surgeon experience.
微创腹部手术中初始端口放置时发生的损伤很少见，但可能导致严重的发病率。我们旨在描述初始端口放置时发生损伤的发生率、后果和危险因素。
这是对我们机构的普通外科质量协作数据库进行的回顾性研究，同时补充了 2018 年 6 月 25 日至 2022 年 6 月 30 日期间发病率和死亡率会议数据库的输入。评估了患者特征、手术细节和术后过程。将有入口损伤的病例与无入口损伤的病例进行比较，以确定损伤的危险因素。
两个数据库中共有 8844 例微创病例。在初始端口放置过程中发生了 34 例损伤（0.38%）。71%的损伤为肠损伤（全层或部分厚度），大多数（79%）损伤在指数手术中发现。发生损伤的病例中位手术医生经验为 9 年（IQR 4.25-14.5），而参与数据库的所有医生的经验中位数为 12 年（p=0.004）。既往剖腹术与入口处损伤的发生率也显著相关（p=0.012）。根据进入方式，损伤发生率没有显著差异（切开：19（55.9%），无 Veress 的光学进入：10（29.4%），Veress 后光学进入：5（14.7%），p=0.11）。BMI>30kg/m2（损伤：16/34 vs 无损伤：8844/8844，p=0.847）与损伤无关。初始端口放置时发生损伤的 56%（19/34）的患者在住院期间的某个时间点需要剖腹术。
微创腹部手术中初始端口放置时发生损伤很少见。在我们的数据库中，既往剖腹术史是损伤的一个显著危险因素，似乎比常见的因素如技术、患者体型或手术医生经验更具后果。
