腹腔鏡手術における第1トロカー挿入法に関する検討

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  • The first trocar insertion technique in laparoscopic surgery: A retrospective study

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<p>Objective: Insertion of the first trocar in laparoscopic surgery is associated with severe intestinal and vascular injuries; therefore, several techniques have been introduced to minimize complications. We retrospectively compared the open access technique (OAT) vs. direct optical access (DOA) to determine an easy and safe approach.</p><p>Method: We retrospectively reviewed records of patients who underwent laparoscopic surgery at two facilities (OAT was performed at one and DOA at the other) affiliated to our hospital between January 2018 and December 2018. We compared OAT and DOA with regard to the following parameters to determine the user-friendliness of each method: (1) time required for first trocar insertion and wound closure, (2) time required for first trocar insertion in patients with body mass index (BMI) >25 kg/m2 and <25 kg/m2, (3) time required for first trocar insertion based on the surgeon's experience (gynecological vs. non-gynecological specialists) and, (4) complications.</p><p>Results: The OAT and DOA groups included 104 and 142 patients, respectively. The mean times for first trocar insertion and wound closure were significantly shorter in the DOA group (p<0.01). No significant intergroup difference was observed in first trocar insertion time based on the BMI (OAT: p=0.588, DOA: p=0.216). The first trocar insertion time was significantly shorter in the OAT group when the procedure was performed by a specialist; however, no significant difference was observed in the DOA group (OAT: p=0.018, DOA: p=0.052). No complications occurred in either group during the study period.</p><p>Conclusion: DOA was technically easier than OAT; it was more effective in patients with mild obesity and was a simple technique that could be performed by less experienced surgeons and beginners.</p><p></p>

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