Comparison of Abdominal Initial Entry Techniques in Gynecological Laparoscopy

Year 2023, Volume: 13 Issue: 5, 791 - 795, 30.09.2023

Elif Gundogdu Taner Usta

https://doi.org/10.16899/jcm.1338911

Abstract

Objective: The aim of this study is to assess the safety of laparoscopic entry techniques.
Materials and Methods: Within the scope of the study, medical records of patients who underwent laparoscopy due to various gynecological indications at our clinic between January 1, 2011, and July 1, 2015, were examined. Evaluation was conducted using our hospital’s electronic database.
Results: In the patient cohort, direct trocar placement was preferred in 91.8% (1025 patients), Veress needle placement was used in 7.4% (82 patients), and an open technique was used in 0.8% (9 patients). In terms of entry sites, umbilicus was the most commonly chosen option, being preferred in 97.2% (1085 patients) of cases. In 2.4% of patients (27 patients), the midline abdominal trocar was preferred as the initial trocar insertion site. Among these patients, suprapubic incision was preferred in 62% (17 patients), while Lee-Huang point was chosen as the entry site in 38% (10 patients).Looking at the history of previous surgeries, 18.5% (206 patients) had a history of prior abdominal surgery, and 3.5% (39 patients) had undergone two previous surgical procedures. Only 0.1% (1 patient) had undergone three or more abdominal surgeries.
Discussion: In conclusion, no clear superiority of one initial entry technique over another has been proven. Despite the extensive literature on laparoscopic entry, debates regarding the most effective method to prevent significant complications continue.

Keywords

abdominal entry, direct trocar entry, laparoscopy, technique, complication

Jinekolojik Laparoskopi abdominal ilk giriş tekniklerinin karşılaştırılması

Abstract

Amaç: Bu çalışmanın amacı, laparoskopik giriş tekniklerinin güvenliğini değerlendirmektir.
Gereç ve Yöntem: Çalışma kapsamında, 1 Ocak 2011 ile 1 Temmuz 2015 tarihleri arasında kliniğimizde çeşitli jinekolojik endikasyonlar nedeniyle laparoskopi geçiren hastaların tıbbi kayıtları incelenmiştir. Hastanemizin elektronik veritabanı kullanılarak değerlendirme yapılmıştır.
Bulgular: Hasta kohortu içinde, doğrudan trokar yerleştirilmesi %91.8’lik bir tercih oranıyla (1025 hasta), Veress iğnesi yerleştirilmesi %7.4’lük bir oranla (82 hasta) ve açık bir teknik %0.8’lik bir oranla (9 hasta) kullanılmıştır. Giriş bölgeleri açısından, umblikus vakaların %97.2’sinde (1085 hasta) tercih edilmiştir.Hastaların %2.4’ünde (27 hasta), ilk trokar giriş yeri olarak trokar orta hat abdomen tercih edilmiştir. Bu hastaların %62’sinde (17 hasta) suprapubik insizyonu tercih edilirken, %38’inde (10 hasta) giriş noktası olarak Lee-Huang noktası seçilmiştir. Geçmiş cerrahi öyküsüne bakıldığında, hastaların %18.5’inde (206 hasta) bir önceki karın cerrahisi operasyonu bulunurken, %3.5’inde (39 hasta) iki önceki cerrahi operasyonu bulunmaktadır. Yalnızca %0.1’i (1 hasta), üç veya daha fazla abdominal cerrahi geçirmiştir.
Tartışma: Sonuç olarak, bir ilk giriş tekniğinin diğerine göre açık bir üstünlüğü kanıtlanmamıştır. Laparoskopik giriş hakkında yaygın literatür olmasına rağmen, önemli komplikasyonları önlemek için en etkili yöntem konusundaki tartışmalar devam etmektedir.

Keywords

Abdominal giriş, Direct trokar girişi, laparoskopi, teknikler, komplikasyon

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