Establishing pneumoperitoneum: Verres or Hasson? The debate continues
Establishing pneumoperitoneum: Verres or Hasson? The debate continues
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DOI：
10.1308/003588411x12851639107557
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发表时间：
2011-01-01
影响因子：
1.4
通讯作者：
Dehn, T. C. B.
中科院分区：
文献类型：
--
作者：
Dunne, N.;Booth, M. I.;Dehn, T. C. B.
引言建立腹腔镜手术的气腹技术仍然存在争议，有各种不同的技术，每一个都有自己的倡导者。Verres针的方法引起了很多批评，并被认为会带来更多的风险，但这种观点在循证医学时代是合理的吗？患者和方法：在6年的时间里，对3126例接受由两名上消化道外科医生进行的腹腔镜手术的患者进行了前瞻性研究。一名外科医生首选Verres针，另一名外科医生首选开放技术。建立了一个数据库，所有的情况下，并发症发生率的不同techniques.Results笔脐Verres针使用1887例（60.4%），有两个并发症，这两个都是结肠损伤，发病率为0.1%。在1200例（38.4%）病例中使用了开放端口插入，发生了1例并发症，即小肠穿孔，发生率为0.08%。22例（0.75%）在不同位置使用Verres针，当用于左上象限（19例）时，有1例并发症，即左肝叶穿刺，发生率为5.26%。我们的腹腔内损伤总发生率为0.13%，均发生在既往接受过腹部手术的患者中，在既往接受过手术的患者亚组中，发生率为0.78%。有没有mortality.CONCLUSIONS实践不同的方法选择诱导气腹，但我们的研究结果表明，选择的技术和并发症的发生率之间没有显着差异，这是在文献中支持。
INTRODUCTION The technique of establishing pneumoperitoneum for laparoscopic surgery remains contentious, with various different techniques available and each having its own advocates. The Verres needle approach has attracted much criticism and is seen to entail more risk, but is this view justified in the era of evidence-based medicine?PATIENTS AND METHODS Over a 6-year period, a prospective study was undertaken of 3126 patients who underwent laparoscopic surgery performed by two upper gastrointestinal surgeons. One surgeon preferred the Verres needle and the other an open technique. A database was created of all cases and complication rates of the different techniques ascertained.RESULTS Pen-umbilical Verres needle was used in 1887 cases (60.4%) with two complications encountered, both of which were colonic injuries, with an incidence of 0.1%. Open port insertion was used in 1200 cases (38.4%) with one complication, a small bowel perforation, to give an incidence of 0.08%. The Verres needle was used in alternative positions in 22 cases (0.75%) and, when used in the left upper quadrant (19 cases), there was one complication, a left hepatic lobe puncture, with an incidence of 5.26%. Our overall incidence of intra-abdominal injury was 0.13%, all in patients who had undergone previous abdominal surgery, and in the subgroup of patients with previous surgery the rate was 0.78%. There was no mortality.CONCLUSIONS Practice varies as to the method chosen to induce pneumoperitoneum, but our results show there is no significant difference between the technique chosen and incidence of complications, and this is supported in the literature.