Complications of laparoscopy: An inquiry about closed- versus open-entry technique
Complications of laparoscopy: An inquiry about closed- versus open-entry technique
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DOI：
10.1016/j.ajog.2003.09.035
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发表时间：
2004-03-01
影响因子：
9.8
通讯作者：
Trimbos, JB
中科院分区：
文献类型：
--
作者：
Jansen, FW;Kolkman, W;Trimbos, JB
目的：本研究的目的是确定荷兰妇科腹腔镜术中并发症的数量和开放与闭合(Veress针或第一针)技术的发生率。研究设计：结合Medline文献检索，对荷兰妇科内窥镜和微创外科学会成员进行问卷分析。采用问卷调查的方法收集1997年1月1日至2001年12月31日入院时并发症的相关资料，分为两组：第1组(Veress针或第一针)和第11组(开腹)。收集腹腔镜手术次数、多年经验和手术指征。结果：有效率为98%。这些手术由荷兰74家医院(72%)的187名妇科医生进行。I组和II组在临床类型(教学医院和非教学医院)、手术次数和妇科医生的经验方面具有可比性。106名妇科医生(57%)只使用闭合进入技术。这一组报告了31,532例手术中的31例并发症(0.1%)。即使在有进入相关并发症(既往剖腹手术、肥胖)风险的患者中，气腹也是通过闭合进入技术建立的。然而，大多数妇科医生使用了替代的注气点(例如，帕尔默氏点)。剩下的81名妇科医生使用了这两种输入技术。然而，开放入路技术用于特殊适应症，仅有2.0%的病例(范围：1-20%)。这些特殊指征是可疑粘连或既往剖腹手术(90%)，肥胖(7%)或非常瘦的患者(3%)。81名妇科医生报告了20027例闭门手术和579例开放手术，并发症发生率分别为0.12%和1.38%(P
Objective: The purpose of this study was to determine the amount of complications and the incidence of open- versus closed-entry (either by Veress needle or first trocar) technique in gynecologic laparoscopy in The Netherlands.Study design: Questionnaire analysis of members of the Dutch Society for Gynaecological Endoscopy and Minimal Invasive Surgery was combined with a Medline literature search. Data related to complications on entry from January 1,1997, through December 31, 2001, were collected by questionnaire and were separated into group I (Veress needle or first trocar) and group 11 (open-entry technique). The number of laparoscopy procedures, years of experience, and indications to perform the chosen entry technique were collected.Results: Response rate was 98%. The procedures were performed by 187 gynecologists in 74 hospitals (72%) in The Netherlands. Groups I and II were comparable to each other, with respect to type of clinic (teaching vs nonteaching hospital), the number of procedures, and the experience of gynecologists. One hundred six gynecologists (57%) used only the closed-entry technique. This group reported 31 complications (0.1%) in 31,532 procedures. Even in the case of patients who were at risk for entry-related complications (previous laparotomy, obesity), pneumoperitoneum was established by the closed-entry technique. However, most gynecologists used an alternative insufflation point (eg, Palmer's point). The remaining 81 gynecologists used both entry techniques. However, the open-entry technique was used on special indications and in only 2.0% of cases (range: 1-20%). These special indications were suspected adhesions or previous laparotomy (90%) and obese (7%) or very thin patients (3%). These 81 gynecologists reported 20,027 closed-entry procedures and 579 open-entry procedures and complication rates of 0.12% and 1.38%, respectively (P