ABSTRACT
Objective To evaluate the clinical significance of direct trocar insertion using optical trocar in the establishment of the primary port during trans-peritoneal laparoscopic surgical procedures.Methods A prospective study was conducted by collecting the data of 120 patients who should be performed abdominal laparoscopic surgery from April 2015 to December 2015.The 120 patients were randomly divided into a research group and a control group.The research group consisted of 34 male patients and 26 female patients,mean age was (52.0 ± 11.9) years and mean BMI was (24.9 ± 2.9) kg/m2.In research group,patients were positioned laterally with the flank padded and elevated.A predetermined position was drawn prior to surgery between the umbilicus and lateral rectus abdominis,for the creation of the primary laparoscopic trocar port.The predetermined point was incised,and then the method of direct trocar insertion using the optical access trocar was used for establishment of the primary port.After this maneuver was completed the surgery continued as indicated.The control group consisted of 36 male patients and 24 female patients,whose mean age was (52.9 ± 11.4) years and mean BMI was (25.2 ± 2.4) kg/m2.This group underwent the traditional method of port construction by incision into the abdomen.The time of constructing the passage,leakage rate,bleeding rate,and injury rate of abdominal organs were compared.Results In research group,the time of building primary port was clearly shorter than that in control group (2.7min vs.15.9min,P ＜ 0.05),the leakage rate was also obviously reduced compared to that in control group (0 vs.30％,P ＜ 0.05).Neither groups observed any significant bleeding nor visceral organ damage throughout the study.Conclusion Direct trocar insertion using optical trocar to establish observation port is a highly efficient and safe method in trans-peritoneal laparoscopic operation,which should be research thoroughly in clinical practice.
ABSTRACT
Objective To improve the awareness of pel vi c lipomatosis in clinical practice. Methods A 51-year- old male patient with pelvic lipomatosis was admitted. Imaging studies showed th at there was mild degree of hydronephrosis on his both sides on IVU and a typica l inverted-pear shape of bladder and extended posterior urethra were also seen on IVU.CT scan showed that low density lipid piled in the pelvic cavity.MRI show ed obvious thickened soft tissue lesion around the bladder,rectum and in the pel vic cavity. The lesions in the pelvic cavity and around the ureters were removed and the lower segments of the ureters were loosened by laparoscopic surgery. Th e clinical characteristics of lipomatosis were reviewed by combination with the literature. Results Intraoperatively,apparently increase d lipid tissue was found in the pelvic cavity and there was large amount of lipi d tissue filling the space around bladder,rectum and sigmoid colon.This finding was consistent with the imaging study findings.About 500g lipid tissue was remov ed in the laparoscopic procedure.Pathologic study showed it was mature lipid tis sue.The patient was discharged 1 week after surgery.Two weeks after surgery,B-u ltrasound showed that there was improvement of hydronephrosis on both sides.The maximum width of right renal fluid sonolucent area decreased from 2.9 cm to 2.0 cm;the width of right upper ureter decreased from 1.2 cm to 1.0 cm;the maximum w idth of left renal pelvis decreased from 1.8 cm to 1.3 cm;and the width of left upper ureter decreased from 0.8 cm to 0.5 cm. Conclusions X-ray,CT scan and MRI are the most valuable examinations in the diagnosis of lipomatosis.Removing the lipid in the pelvis and around the bladder and loosenin g the ureters by laparoscopic surgery are minimally invasive,safe and effective in the treatment of pelvic lipomatosis.