Department of Next Generation Endoscopic Intervention (Project ENGINE), Graduate School of Medicine, Osaka University, Osaka, Japan.
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
Minim Invasive Ther Allied Technol. 2023 Aug;32(4):183-189. doi: 10.1080/13645706.2023.2211661. Epub 2023 Jun 8.
There is an ongoing concern about the potential infectious risk due to pneumoperitoneal gas leakage from surgical trocars in laparoscopic surgery. We aimed to visually confirm the presence of leakage from trocars and investigate the changes in the leakage scale according to intra-abdominal pressures and trocar types. We established a porcine pneumoperitoneum model and performed experimental forceps manipulation using 5-mm grasping forceps with 12-mm trocars. The gas leakage, if any, was imaged using a Schlieren optical system, which can visualize minute gas flow invisible to the naked eye. For measuring the scale, we calculated the gas leakage velocity and area using image analysis software. Four types of unused and exhausted disposable trocars were compared. Gas leakage was observed from trocars during forceps insertion and removal. Both the gas leakage velocity and area increased as the intra-abdominal pressure increased. Every type of trocar we handled was associated with gas leakage, and exhausted disposable trocars had the largest scale gas leakage. We confirmed gas leakage from trocars during device traffic. The scale of leakage increased with high intra-abdominal pressure and with the use of exhausted trocars. Current protection against gas leakage may not be sufficient and new surgical safety measures and device development may be needed in the future.
腹腔镜手术中，由于手术套管内的气腹向腹腔内泄漏，存在潜在的感染风险，这一问题引起了持续关注。本研究旨在通过可视方法确认套管是否存在泄漏，并根据腹腔内压力和套管类型研究泄漏程度的变化。我们建立了一个猪的气腹模型，使用 5mm 持针钳和 12mm 套管进行了实验性钳夹操作。如果存在任何气体泄漏，我们将使用可以观察到肉眼不可见的微小气流的光学纹影系统对其进行成像。为了测量泄漏程度，我们使用图像分析软件计算了气体泄漏速度和面积。我们比较了 4 种未使用和已用尽的一次性套管。在进行钳子插入和拔出操作时，从套管中观察到了气体泄漏。随着腹腔内压力的增加，气体泄漏速度和面积均增加。我们处理的每种套管都与气体泄漏有关，而用尽的一次性套管的气体泄漏程度最大。我们在器械操作过程中确认了套管的气体泄漏。随着腹腔内压力的升高和用尽套管的使用，泄漏程度增加。目前对气体泄漏的防护可能不足，未来可能需要新的手术安全措施和器械开发。
