Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Ferrara, Italy.
Policlinico Abano Terme, Abano Terme, Padua, Italy.
Langenbecks Arch Surg. 2023 Apr 17;408(1):152. doi: 10.1007/s00423-023-02891-8.
Direct insertion of the trocar is an alternative method to Veress needle insertion for the creation of pneumoperitoneum. We conducted a systematic review and meta-analysis to compare these two entry closed techniques.
A systematic review of the literature was done on PubMed, MEDLINE, Embase, Scopus, and EBSCO.
The literature search was constructed until May 01, 2022, around search terms for "Veress," "direct trocar," "needle," "insertion," and "laparoscopic ways of entry." This systematic review was reported according to the PRISMA Statement 2020.
Sixteen controlled trials (RCTs) and 5 observational studies were included in the systematic review. We found no significant differences in the risk of major complication during the access manoeuvres between DTI and VN: bowel injuries (OR = 0.76, 95% CI: 0.24-2.36, P = 0.63), major vascular injuries (OR = 1.74, 95% CI 0.56-5.38, P = 0.34), port site hernia (OR = 2.41, 95% CI: 0.28-20.71, P = 0.42). DTI has a lower risk of minor complications such as subcutaneous emphysema (OR = 5.19 95% CI: 2.27-11.87, P < 0.0001), extraperitoneal insufflation (OR = 5.93 95% CI: 1.69-20.87, P = 0.006), omental emphysema (OR = 18.41, 95% CI: 7. 01-48.34, P < 0.00001), omental bleeding (OR = 2.32, 95% CI: 1.18-4.55, P = 0.01), and lower number of unsuccessful entry or insufflation attempts (OR = 2.25, 95% CI: 1.05-4.81, P = 0.04). No significant differences were found between the two groups in terms of time required to achieve complete insufflation (MD = - 15.53, 95% CI: - 91.32 to 60.27, P = 0.69), trocar site bleeding (OR = 0.66, 95% CI, 0.25-1.79, P = 0.42), and trocar site infection (OR = 1.19, 95% CI, 0.34-4.20, P = 0.78).
There were no statistically significant differences in the risk of major complications during the access manoeuvres between DTI and VN. A lower number of minor complications were observed in DTI compared with those in Veress access.
套管直接插入是一种替代 Veress 针插入以建立气腹的方法。我们进行了一项系统评价和荟萃分析，以比较这两种封闭入口技术。
在 PubMed、MEDLINE、Embase、Scopus 和 EBSCO 上进行了系统的文献检索。
文献检索截止到 2022 年 5 月 1 日，围绕“Veress”、“直接套管”、“针”、“插入”和“腹腔镜进入方式”等术语进行。本系统评价根据 PRISMA 声明 2020 进行报告。
纳入了 16 项对照试验（RCT）和 5 项观察性研究。我们发现 DTI 和 VN 在进入操作过程中主要并发症的风险没有显著差异：肠损伤（OR=0.76，95%CI：0.24-2.36，P=0.63）、大血管损伤（OR=1.74，95%CI 0.56-5.38，P=0.34）、端口疝（OR=2.41，95%CI：0.28-20.71，P=0.42）。DTI 有较低的小并发症风险，如皮下气肿（OR=5.19，95%CI：2.27-11.87，P<0.0001）、腹膜外充气（OR=5.93，95%CI：1.69-20.87，P=0.006）、网膜气肿（OR=18.41，95%CI：7.01-48.34，P<0.00001）、网膜出血（OR=2.32，95%CI：1.18-4.55，P=0.01）和较少的不成功进入或充气尝试（OR=2.25，95%CI：1.05-4.81，P=0.04）。两组在达到完全充气所需的时间（MD=-15.53，95%CI：-91.32 至 60.27，P=0.69）、套管部位出血（OR=0.66，95%CI，0.25-1.79，P=0.42）和套管部位感染（OR=1.19，95%CI，0.34-4.20，P=0.78）方面无统计学显著差异。
在进入操作过程中，DTI 和 VN 之间主要并发症的风险没有统计学上的显著差异。与 Veress 进入相比，DTI 观察到的小并发症数量较少。
