Importance of Safe Access Technique in Laparoscopic Surgery
The main challenge facing the laparoscopic surgery is the primary abdominal access, as it is usually a blind procedure associated with vascular and visceral injuries. Complications associated with laparoscopy are often related to entry. The life-threatening complications include injury to the bowel, bladder, major abdominal vessels, and anterior abdominal-wall vessel. Other less serious complications can also occur, such as post-operative infection, subcutaneous emphysema and extraperitoneal insufﬂation. There is no clear consensus as to the optimal method of entry into the peritoneal cavity. It has been proved from studies that 50% of laparoscopic major complications occur prior to the commencement of the surgery. The surgeon must have adequate training and experience in laparoscopic robotic surgery before intending to perform any procedure independently. He /she should be familiar with the robotic equipments, instrument and energy source he intends to use. The incidence of complications according to different techniques used for inducing pneumoperitoneum in laparoscopic robotic surgery was studied.
Prospective and retrospective data was collected for (50) patients underwent laparoscopic surgery from September 2015 to September 2016 in World Laproscopy Hospital , all these patients were operated here using different entry techniques. Three hundred and sixty patients underwent laparoscopic surgery;. The operations included in our study were Totla laproscopic hysterectomy (254), diagnostic laparoscopy for infertility and abdominal pathology (56), ovarian cystectomy (20), diagnostic hysteroscopy(15), operative hysterscopy(13), sacrocolpopexy (2). The early complications recorded in our study are abdominal wall vascular injuries ,visceral injuries ,bradycardia , preperitoneal insufflations .The incidence of laproscopic entry related injuries in gynecological operations was 6.9% .But the incidence of laproscopic entry related injuries in major pelvic operations was 7.8%. Peritoneal insufflations by Co2 done by different entry techniques as follow; 1-veress trocar: used in (222) patients. 2-veress needle: used in (31) patients. 3-blunt trocar: used in (30) patients. 4-sharp trocar: used in (27) patients. 5-visiport: used in (20) patients. 6-palmer technique: (20) patients; used when the patients have umbilical scar . 7-Hasson technique: used in (10) patients.
There appears to be no evidence of beneﬁt in terms of safety of one technique over another. However, the included studies are small and cannot be used to conﬁrm safety of any particular technique. No single technique or instrument has been proved to eliminate laparoscopic entry associated injury. Proper evaluation of the patient, supported by good surgical skills and reasonably good knowledge of the technology of the instruments remain to be the cornerstone for safe access and success in minimal access surgery.
|Older Post||Home||Newer Post|