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An alternative access technique under direct vision for preperitoneoscopic pelvic surgery: easier for the beginners.

机译:腹腔镜前盆腔手术的直视下的另一种接入技术:对于初学者来说更容易。

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BACKGROUND: We present an alternative access technique to facilitate preperitoneoscopic (extraperitoneal laparoscopic) approach for radical prostatectomy, herniorrhaphy, and other pelvic procedures. METHODS: A 0 degrees telescope was mounted into a Visiport Optical Trocar (Visiport), and via a periumbilical incision it was advanced under direct vision at first vertically through different layers of the anterior abdominal wall. Immediately before the posterior rectus sheath, it was redirected caudally and horizontally toward the symphysis pubis. The Visiport was withdrawn and replaced by a dissection balloon that was inflated for developing the working space, then it was substituted with a 12-mm trocar to begin the pneumo-extraperitoneum. The surgical procedures are detailed in the attached video. RESULTS: This technique was used in 168 of 179 patients undergoing preperitoneoscopic surgery (97 radical prostatectomies, 80 totally extraperitoneal herniorrhaphies, and 2 urinary bladder diverticulectomies).Operative parameters were compared with 11 preceding patients approached with the open Hasson technique. All of the procedures to create the preperitoneoscopic space were successfully with no complications. For radical prostatectomy, there was a significantly faster access to the preperitoneal space (38 +/- 12 vs 540 +/- 69 seconds) and a faster setup of the whole operative space (15 +/- 5 vs 29 +/- 9 minutes, both P < .05) with the new technique. Less pericannular CO(2) leakage was experienced during the preperitoneoscopy with our technique. CONCLUSION: This alternative technique offers a simple, safe, quick, and effective access for creating a preperitonescopic working space.
机译:背景:我们提出了一种替代的访问技术,以促进腹腔镜(腹膜外腹腔镜)方法进行前列腺癌根治术,疝气和其他盆腔手术。方法:将0度望远镜安装在Visiport光学套管针(Visiport)中,并通过脐带切口在直视下首先垂直穿过前腹壁的不同层前进。在紧接直肠直肌鞘之前,将其尾端和水平方向重新导向耻骨联合。撤回Visiport并用解剖气囊充气,该气囊膨胀后用于扩大工作空间,然后用12毫米的套管针代替,开始了肺外膜。随附视频中详细介绍了手术步骤。结果:该技术用于179例接受腹膜镜手术的患者中的168例(97例行根治性前列腺切除术,80例完全行腹膜外疝气切除术和2例膀胱憩室切除术),并与11例接受开放式Hasson手术的患者进行了手术参数比较。创建腹膜腔镜前间隙的所有程序均成功完成,无任何并发症。对于前列腺癌根治术,进入腹膜前间隙的速度明显更快(38 +/- 12 vs 540 +/- 69秒),整个手术空间的设置也更快(15 +/- 5 vs 29 +/- 9分钟) ,两者P <.05)。腹膜前镜检查期间我们的技术经历较少的瓣膜环CO(2)泄漏。结论:这种替代技术可提供简单,安全,快速和有效的途径来创建腹膜镜检查前的工作空间。

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