ABSTRACT
Background: Laparoscopic sterilization is a widely accepted method of permanent contraception. The techniques of abdominal entry are open direct trocar and veress method. The objectives of this study were to performance and practice of 5mm direct trocar entry techniques in Laparoscopic sterilization. To prepare a list of benefits and complications.Methods: Retrospective analysis of patients who underwent direct 5mm trocar entry for laparoscopic sterilization. Period: 1st April 2017 to 30th November 2017. Patient came on the day of surgery with empty stomach. Intravenous pethedine 50mg and phenergan 12.5mg and antibiotics were given. Injection lignocaine intraumbilically and incision of 5mm was made. 5mm trocar and canula inserted directly. 5mm scope inserted. After ensuring peritoneal cavity, pneumoperitonium created. Secondary 7mm port made under vision and ring applicator inserted and fallop ring applied on both tubes. Port closure done by N Butyl 2 cyano accrylate. Patient was observed for 6 hours and discharged with analgesics and antibiotics.Results: We operated 220 interval sterilizations and 31 posts MTP. In 250 cases, the method was successful. Only in one woman 5mm trocar was insufficient to make peritoneal entry since the patient was morbidly obese. Hence 10mm trocar was used.Conclusions: Laparoscopic tubal sterilization can be done with 5mm laparoscope and direct trocar entry method is safe and saves time.
ABSTRACT
Background: In order to perform laparoscopic procedures, it is necessary to first access the peritoneal cavity and establish carbon dioxide pneumoperitoneum. The placement of the first trocar remains a critical step in laparoscopic surgery. In order to minimize complications associated with placement of first trocar, several techniques have been reported. Author describe a surgical technique that provides a quick, safe, and reliable initial access to the peritoneal cavity with its excellent functional and cosmetic results.Methods: Retrospective study of patients who underwent various laparoscopic procedures at Maxx lyfe Hospital, Bathindi, Jammu was carried out by the closed technique for initial access to the peritoneal cavity through the umbilicus from July 2016 to May 2019. In this study, patients who had a prior midline laparotomy with involvement of the umbilicus were excluded.Results: Authors analyzed 456 patients (M = 190; F = 266) in the study period. Average age of the patients was 32 years (range:12-86). A physiologic defect was identified in the umbilical region in all patients who had no history of previous abdominal surgery in that region. The average time to access the peritoneal cavity was 30 seconds (range: 20-50).Conclusions: This technique is quick, safe, reliable, simple, and easy to learn and easy to perform. It is associated with no mortality and minimal morbidity and has excellent cosmetic results. Based on authors experience, authors believe that this method provides surgeons with an effective and safe way to insert the first trocar and recommend it as a routine procedure to access the peritoneal cavity for abdominal laparoscopic surgery.
ABSTRACT
Background: The aim of this paper is to compare the outcomes of veress needle entry versus direct trocar for laparoscopy in terms of the duration of the procedure, ease of performance and the complications encountered during each technique.Methods: The present study was conducted on a retrospective basis from April ‘2008 to September 2017, in the dept of Obstetrics and Gynecology, in a 100 bedded hospital, ABGH hospital. All the cases who underwent laparoscopic ligation procedure during this time were taken into account. From 2008 to 2012 traditional technique of veress needle entry was used for access(group -1) but it had been switched over to direct trocar since 2013(group -2) These two groups were compared in terms of the demographic profile, duration of procedure, previous h/o surgical interventions ,ease of performance and various complications encountered during the procedure.Results: The total number of patients who underwent ligation during this period were 1912, which were divided into two groups ,till 2012(veress needle entry group,group-1) 754 patients(39.44%),and after 2012 (direct trocar,group -2) 1158 patients(60.56%).Duration of procedure was 4.5±1.2 min in group 1 which was significantly higher than group 2,2.2±0.8 min(p-value <0.001).Amount of gas required was greater in group 1, 4.9±1.3 lts as compared to group 2,2.4±0.5lts.Conclusions: Direct trocar entry is a reliable alternative to traditional technique for pneumoperitoneum establishment and should be regarded as a part of the surgical armamentarium of a trained laparoscopic surgeon.