Four major puncture methods

The operation is very dangerous, and the puncture should be done with caution.

Although the risks of minimally invasive surgery are much safer than those of traditional open surgery, the risks of surgery are still an unavoidable issue. One of the risk factors is puncture, and pneumoperitoneum needle puncture and the placement of the first puncture device are the most dangerous. According to statistics, half of the complications related to laparoscopy are related to puncture. Although intestinal injury or large blood vessel injury caused by puncture is uncommon, they are all potentially life-threatening complications.

All of this is often a bit overwhelming for new doctors who have just entered the profession, so here are four common puncture methods to help you summarize the key points in 30 seconds. I wish you success in gaining extra experience and upgrading!

Closed (Veress stitch)

This method is also called the classic puncture mode. First, insert the pneumoperitoneum needle (usually through the umbilicus), and then insert the first puncture device after pneumoperitoneum is formed. However, the disadvantage is that "blind puncture" can cause damage to the retroperitoneal vessels, abdominal wall vessels and gastrointestinal tract. The difficulty is medium.

Open (Hasson method)

That is, after cutting through the layers of tissue at the umbilicus and entering the abdominal cavity, a blunt puncture device is inserted to form pneumoperitoneum. The disadvantage is that it is time-consuming. If the incision is too large, there is a possibility of air leakage. It is suitable for high-risk patients with a history of abdominal surgery or suspected abdominal adhesions. It can also be used for laparoscopic surgery during pregnancy. It is relatively difficult.

The Hasson disposable trocar designed for open surgery by United Micro-Invasive makes puncture safer and simpler

Direct insertion method

That is, the trocar is inserted directly without forming pneumoperitoneum. It has high technical requirements and is only suitable for experienced surgeons.

The trocar should be at 90° to the abdominal wall. After passing the fascia and reaching the peritoneum, it should be adjusted to 45° to the horizontal plane and slowly enter the abdominal cavity.

Direct vision

That is, after the skin is cut at the location of the first puncture, the laparoscope is inserted into the puncture, and the incision of each layer of abdominal wall tissue can be observed under the microscope, thus ensuring the safety of the operation. This type of puncture generally uses a disposable visual separation puncture. The difficulty is low.