Klinik Araştırma
BibTex RIS Kaynak Göster

Comparison of Abdominal Initial Entry Techniques in Gynecological Laparoscopy

Yıl 2023, , 791 - 795, 30.09.2023
https://doi.org/10.16899/jcm.1338911

Öz

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.

Kaynakça

  • 1. Namnoum AB, Murphy AA: Diagnostic and Operaative Laparoscopy. In: Rock JA, Jones HW, editors. Te Linde’s Operative Gynecology. Philedelphia, Lippincott Company (9. ed.) 2003. Ch 16, p. 353-354.
  • 2. Larsen CR, Grantcharov T, Aggarwal R, Tully A, Sorensen JL, Dalsgaard T, et al. Objective assessment of gynecologic laparoscopic skills using the LapSimGyn virtual reality simulator. Surg Endosc. 2006 Sep;20(9):1460-6.
  • 3. Munz Y, Kumar BD, Moorthy K, Bann S, Darzi A. Laparoscopic virtual reality and box trainers: is one superior to the other? Surg Endosc. 2004 Mar;18(3):485-94.
  • 4. Aggarwal R, Tully A, Grantcharov T, Larsen CR, Miskry T, Farthing A, et al. Virtual reality simulation training can improve technical skills during laparoscopic salpingectomy for ectopic pregnancy. BJOG. 2006 Dec;113(12):1382-7.
  • 5. Azevedo JL, Azevedo OC, Miyahira SA, Miguel GPS, Becker OM, Hypolito OHM, et al. Injuries caused by Veress needle insertion for creation of pneumoperitoneum: a systematic literature review. Surg Endosc. 2009;23:1428–1432.
  • 6. Merlin TL, Hiller JE, Maddern GJ, Jamieson GG, Brown AR & Kolbe A. Systematic review of the safety and effectiveness of methods used to establish pneumoperitoneum in laparoscopic surgery. Br J Surg. 2003;90:668–679.
  • 7. Altun H, Banli O, Kavlakoglu B, Kücükkayikci B, Kelesoglu C, & Erez N. Comparison between direct trocar and Veress needle insertion in laparoscopic cholecystectomy. J Laparoendosc Adv Tech. 2007; 17.6: 709-712.
  • 8. Cakir T, Tuney D, Esmaeilzadem S, & Aktan AO. Safe Veress needle insertion. J Hepatobiliary Pancreat Sci. 2006; 13.3: 225-227.
  • 9. Catarci M, Carlini M, Gentileschi P, Santoro E. Major and minor injuries during the creation of pneumoperitoneum. Surg Endosc. 2001;15:566–569.
  • 10. Tinelli A, Malvasi A, Istre O, Keckstein J, Stark M & Mettler L. Abdominal access in gynaecological laparoscopy: a comparison between direct optical and blind closed access by Verres needle. Eur J Obstet Gynecol Reprod Biol. 2010;148:191–194.
  • 11. Bozkurt M. Comparison of after Veress Closed Trocar and Open Entry Methods inTerms of Efficiency, Complications and Postoperative Pain in Gynecological Laparoscopy: Prospective Study. JAREM. Journal of Academic Research in Medicine. 2012; 2.3: 104.
  • 12. Shayani-Nasab H, Amir-Zarga MA, Mousavi-Bahar SH, Kashkouli A, Ghorban-Poor M, Farimani M, et al. (2013). Complications of entry using direct trocar and/or veress needle compared with modified open approach entry in laparoscopy: six-year experience. Urol. J, 10(2), 861-865.

Jinekolojik Laparoskopi abdominal ilk giriş tekniklerinin karşılaştırılması

Yıl 2023, , 791 - 795, 30.09.2023
https://doi.org/10.16899/jcm.1338911

Öz

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.

Kaynakça

  • 1. Namnoum AB, Murphy AA: Diagnostic and Operaative Laparoscopy. In: Rock JA, Jones HW, editors. Te Linde’s Operative Gynecology. Philedelphia, Lippincott Company (9. ed.) 2003. Ch 16, p. 353-354.
  • 2. Larsen CR, Grantcharov T, Aggarwal R, Tully A, Sorensen JL, Dalsgaard T, et al. Objective assessment of gynecologic laparoscopic skills using the LapSimGyn virtual reality simulator. Surg Endosc. 2006 Sep;20(9):1460-6.
  • 3. Munz Y, Kumar BD, Moorthy K, Bann S, Darzi A. Laparoscopic virtual reality and box trainers: is one superior to the other? Surg Endosc. 2004 Mar;18(3):485-94.
  • 4. Aggarwal R, Tully A, Grantcharov T, Larsen CR, Miskry T, Farthing A, et al. Virtual reality simulation training can improve technical skills during laparoscopic salpingectomy for ectopic pregnancy. BJOG. 2006 Dec;113(12):1382-7.
  • 5. Azevedo JL, Azevedo OC, Miyahira SA, Miguel GPS, Becker OM, Hypolito OHM, et al. Injuries caused by Veress needle insertion for creation of pneumoperitoneum: a systematic literature review. Surg Endosc. 2009;23:1428–1432.
  • 6. Merlin TL, Hiller JE, Maddern GJ, Jamieson GG, Brown AR & Kolbe A. Systematic review of the safety and effectiveness of methods used to establish pneumoperitoneum in laparoscopic surgery. Br J Surg. 2003;90:668–679.
  • 7. Altun H, Banli O, Kavlakoglu B, Kücükkayikci B, Kelesoglu C, & Erez N. Comparison between direct trocar and Veress needle insertion in laparoscopic cholecystectomy. J Laparoendosc Adv Tech. 2007; 17.6: 709-712.
  • 8. Cakir T, Tuney D, Esmaeilzadem S, & Aktan AO. Safe Veress needle insertion. J Hepatobiliary Pancreat Sci. 2006; 13.3: 225-227.
  • 9. Catarci M, Carlini M, Gentileschi P, Santoro E. Major and minor injuries during the creation of pneumoperitoneum. Surg Endosc. 2001;15:566–569.
  • 10. Tinelli A, Malvasi A, Istre O, Keckstein J, Stark M & Mettler L. Abdominal access in gynaecological laparoscopy: a comparison between direct optical and blind closed access by Verres needle. Eur J Obstet Gynecol Reprod Biol. 2010;148:191–194.
  • 11. Bozkurt M. Comparison of after Veress Closed Trocar and Open Entry Methods inTerms of Efficiency, Complications and Postoperative Pain in Gynecological Laparoscopy: Prospective Study. JAREM. Journal of Academic Research in Medicine. 2012; 2.3: 104.
  • 12. Shayani-Nasab H, Amir-Zarga MA, Mousavi-Bahar SH, Kashkouli A, Ghorban-Poor M, Farimani M, et al. (2013). Complications of entry using direct trocar and/or veress needle compared with modified open approach entry in laparoscopy: six-year experience. Urol. J, 10(2), 861-865.
Toplam 12 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi (Diğer)
Bölüm Orjinal Araştırma
Yazarlar

Elif Gundogdu 0000-0003-2961-3831

Taner Usta 0000-0002-2208-3316

Yayımlanma Tarihi 30 Eylül 2023
Kabul Tarihi 5 Eylül 2023
Yayımlandığı Sayı Yıl 2023

Kaynak Göster

AMA Gundogdu E, Usta T. Comparison of Abdominal Initial Entry Techniques in Gynecological Laparoscopy. J Contemp Med. Eylül 2023;13(5):791-795. doi:10.16899/jcm.1338911