Department of Biomechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands.
Department of Surgical Sciences, University of Torino, Turin, Italy.
Surg Endosc. 2023 Sep;37(9):7325-7335. doi: 10.1007/s00464-023-10240-5. Epub 2023 Jul 13.
During laparoscopic surgery, CO insufflation gas could leak from the intra-abdominal cavity into the operating theater. Medical staff could therefore be exposed to hazardous substances present in leaked gas. Although previous studies have shown that leakage through trocars is a contributing factor, trocar performance over longer periods remains unclear. This study investigates the influence of prolonged instrument manipulation on gas leakage through trocars.
Twenty-five trocars with diameters ranging from 10 to 15 mm were included in the study. An experimental model was developed to facilitate instrument manipulation in a trocar under loading. The trocar was mounted to a custom airtight container insufflated with CO to a pressure of 15 mmHg, similar to clinical practice. A linear stage was used for prolonged instrument manipulation. At the same time, a fixed load was applied radially to the trocar cannula to mimic the reaction force of the abdominal wall. Gas leakage was measured before, after, and during instrument manipulation.
After instrument manipulation, leakage rates per trocar varied between 0.0 and 5.58 L/min. No large differences were found between leakage rates before and after prolonged manipulation in static and dynamic measurements. However, the prolonged instrument manipulation did cause visible damage to two trocars and revealed unintended leakage pathways in others that can be related to production flaws.
Prolonged instrument manipulation did not increase gas leakage rates through trocars, despite damage to some individual trocars. Nevertheless, gas leakage through trocars occurs and is caused by different trocar-specific mechanisms and design issues.
在腹腔镜手术中，CO 注入气体会从腹腔泄漏到手术室中。因此，医护人员可能会接触到泄漏气体中存在的有害物质。尽管先前的研究表明，通过套管的泄漏是一个促成因素，但套管在较长时间内的性能仍不清楚。本研究调查了长时间器械操作对套管气体泄漏的影响。
本研究纳入了 25 个直径为 10 至 15 毫米的套管。建立了一个实验模型，以方便在加载下对套管内的器械进行操作。将套管安装到一个定制的气密容器中，用 CO 以 15mmHg 的压力注入，类似于临床实践。使用线性阶段进行长时间的器械操作。同时，向套管套管径向施加固定负载，以模拟腹壁的反作用力。在器械操作之前、之后和期间测量气体泄漏。
在器械操作后，每个套管的泄漏率在 0.0 至 5.58 升/分钟之间变化。在静态和动态测量中，长时间操作前后的泄漏率没有明显差异。然而，长时间的器械操作确实对两个套管造成了可见的损坏，并在其他套管中发现了与生产缺陷有关的意外泄漏途径。
尽管个别套管受到损坏，但长时间的器械操作并未增加套管的气体泄漏率。然而，套管确实会发生气体泄漏，这是由不同的套管特定机制和设计问题引起的。
