Kumar Saakshie, Dubey Indu B, Aggarwal Vridhi Chand, Soni Rajesh K
Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND.
Cureus. 2024 Feb 23;16(2):e54770. doi: 10.7759/cureus.54770. eCollection 2024 Feb.
Background The creation of pneumoperitoneum is the first step in any laparoscopic surgery. There are various methods of creating pneumoperitoneum which can be divided into open or closed methods. The closed method involves the blind insertion of the Veress needle into the peritoneal cavity. The open technique involves making an incision and then dissecting the fascia to the peritoneal cavity to introduce the cannula under direct vision. This study was conducted to evaluate the safety and efficacy of open (Hasson's) and closed (Veress) techniques of intraperitoneal access for the creation of pneumoperitoneum in laparoscopic surgery. Material and methods The study was conducted in the Department of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. This was a prospective observational study and a total of 100 patients of laparoscopic surgeries fulfilling inclusion criteria were included in the study - 50 patients in group A undergoing the open method of creating pneumoperitoneum and 50 patients in group B undergoing the closed method of creating pneumoperitoneum were evaluated for the study period of 18 months from October 2020 through June 2022. Results The mean time to create pneumoperitoneum was 5.3 ± 1.41 minutes in the open method and 6.21 ± 1.36 minutes in the closed method. The mean time for umbilical port closure in our study was 7.33 ± 1.66 in the open group and 8.86 ± 2.19 in the closed group. In our study, there was no vascular or visceral injury noted in either of the methods used for the creation of pneumoperitoneum. Post-operative complications were almost equal in both the groups. Conclusions Both open and closed methods of intraperitoneal access are safe and effective for the creation of pneumoperitoneum during abdominal laparoscopy. The open method of creating pneumoperitoneum in laparoscopic surgery is a quicker method for the creation of pneumoperitoneum as compared to the closed method of intraperitoneal access.
建立气腹是任何腹腔镜手术的第一步。建立气腹有多种方法，可分为开放法或闭合法。闭合法是将韦雷氏针盲目插入腹腔。开放技术是先做一个切口，然后将筋膜解剖至腹腔，在直视下插入套管。本研究旨在评估腹腔镜手术中开放（哈森氏）和闭合（韦雷氏）腹腔穿刺技术建立气腹的安全性和有效性。
本研究在新德里瓦尔丹·马哈拉施特拉医学院和萨夫达容医院普通外科进行。这是一项前瞻性观察研究，共有100例符合纳入标准的腹腔镜手术患者纳入研究——2020年10月至2022年6月为期18个月的研究期间，对A组50例采用开放法建立气腹的患者和B组50例采用闭合法建立气腹的患者进行评估。
开放法建立气腹的平均时间为5.3±1.41分钟，闭合法为6.21±1.36分钟。本研究中，开放组脐部切口闭合的平均时间为7.33±1.66分钟，闭合组为8.86±2.19分钟。在本研究中，两种建立气腹的方法均未发现血管或内脏损伤。两组术后并发症几乎相同。
开放和闭合腹腔穿刺方法在腹部腹腔镜手术中建立气腹均安全有效。与闭合腹腔穿刺法相比，腹腔镜手术中开放法建立气腹是一种更快的方法。
