Nuzzo G, Giuliante F, Tebala G D, Vellone M, Cavicchioni C
Department of Geriatric Surgery, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy.
J Am Coll Surg. 1997 Jan;184(1):58-62.
The "blind" insertion of the Veress needle for insufflation of the peritoneal cavity with subsequent closed placement of the first trocar during laparoscopic abdominal procedures can result in severe major vascular and visceral injuries. An open technique was proposed as an alternative method for insufflation in patients with abdominal scars to reduce the possibility of such complications. The aim of this article is to report the results of our experience with the routine use of open technique in laparoscopic surgery.
Open technique was routinely used and prospectively evaluated in 330 patients who underwent laparoscopic procedures.
Laparoscopic conversion was necessary in 25 out of 330 cases (7.6 percent): in 20 cases for unclear biliary anatomy during laparoscopic cholecystectomy, and in 5 cases for minor hemorrhage that could not be managed by laparoscopy. In the 305 procedures completed by laparoscopy, 11 patients (3.6 percent) had 13 postoperative complications. These complications were all of minor importance and were always unrelated to trocar insertion; in particular, no major vascular or visceral injuries were observed.
Routine use of open technique for pneumoperitoneum represents the best prevention of most of the severe trocar-related complications that are potentially avoidable.
在腹腔镜腹部手术中，使用韦雷氏针“盲目”插入腹腔进行充气，随后封闭放置第一根套管针，可能会导致严重的大血管和内脏损伤。有人提出开放技术作为腹部有瘢痕患者充气的替代方法，以降低此类并发症的发生可能性。本文旨在报告我们在腹腔镜手术中常规使用开放技术的经验结果。
对330例行腹腔镜手术的患者常规使用开放技术并进行前瞻性评估。
330例中有25例（7.6%）需要转为开腹手术：20例是因为腹腔镜胆囊切除术中胆道解剖结构不明确，5例是因为腹腔镜无法处理的少量出血。在305例完成腹腔镜手术的患者中，11例（3.6%）出现了13例术后并发症。这些并发症都不太严重，且都与套管针插入无关；特别是未观察到重大血管或内脏损伤。
常规使用开放技术建立气腹是预防大多数潜在可避免的与套管针相关严重并发症的最佳方法。
