Raziye DESDİCİOĞLU, Fatih DEMİR, Sefa KELEKÇİ, Aslı Deniz ÖZDEMİR

Endoskopik Cerrahide Kullanılan Trokar Tipleri Komplikasyon Oranlarını Etkiler mi?

Amaç: Laparoskopide kullanılan keskin ve künt uçlu trokar tiplerinin birbirlerine göre avantaj ve dezavantajları vardır. Çalışmamızda komplikasyon oranları ile trokar tipleri arasındaki ilişkiyi araştırmayı amaçladık.Gereç ve Yöntemler: Retrospektif olarak elektronik hasta kayıt sisteminden kliniğimizde yapılan laparoskopi vakalarının verileri incelendi.Bulgular: Toplam 226 hastanın verileri değerlendirildi piramidal keskin, n: 97; konik künt, n:129 . Hastalarda kullanılan trokar tiplerine göre yaş, BMI, hospitalizasyon süresi ve hemoglobin değişiklikleri açısından fark izlenmedi. Operasyon süresinde istatistiksel olarak anlamlı olmayan fark izlendi piramidal keskin: 106,7±35,7; konik künt 101,6±38,2, P:0,17 . Epigastrik arter yaralanması piramidal keskin: 0,10±0,3; konik künt: 0,00±0,00; P:0,00 , kan transfüzyon ihtiyacı piramidal keskin: 0,09±0,2; konik künt: 0,04±0,2, P: 0,01 ve analjezik ihtiyacının piramidal keskin: 2,8±1,8; konik künt 2,2±1,2; P: 0,001 ise piramidal keskin trokar kullanılanlarda anlamlı olarak fazla olduğu saptandı.Sonuç: Piramidal keskin uçlu trokarlar daha fazla doku hasarı ve vasküler yaralanmaya yol açmaktadırlar. Çalışmamızda özellikle ikinci port girişinde epigastrik arter yaralanmasının piramidal keskin uçlu trokarlarla doğrudan ilişkili olduğu saptandı.

Anahtar Kelimeler:

Komplikasyon, laparoskopi, trokar tipleri, vaskülar yaralanma

Does The Trocar Type Affect The Complication Rate In Endoscopic Surgery?

Aim: Sharp and blunt trocars are two types of trocars that are used in laparoscopy and there are some advantages and disadvantages when they are compared each other. In this study, we aimed to research into the relationship between the complication rates and trocar types.Material and Methods: In this retrospective study, we evaluated that data of laparascopic cases performed in our clinic obtained from electronic patient record system.Findings: The data of 226 patients were evaluated pyramidal cutting sharp , n: 97; conic blunt , n:129 . According to the types of trocars applied on patients, there were no difference in terms of age, Body Mass Index BMI , hospitalization duration and hemoglobin changes. A statistically insignificant difference was found on operation time. pyramidal cutting: 106,7±35,7; conic blunt 101,6±38,2, P:0,17 . On the other hand, epigastric artery injury pyramidal cutting: 0,10±0,3; conic blunt: 0,00±0,00; P:0,00 , blood transfusion requirement pyramidal cutting: 0,09±0,2; conic blunt: 0,04±0,2, P: 0,01 and requirement for analgesics pyramidal cutting: 2,8±1,8; conic blunt: 2,2±1,2; P: 0,001 were determined to be significantly more in those operations that pyramidal cutting trocars were used.Conclusion: In our study, it was determined that the epigastric artery injury in the second port entry in particular might be associated with the pyramidal cutting- tip trocars.

Keywords:

Complication, laparoscopy, types of trocars, vascular injury,

PDF

___

Park D, Kim J, Jun HS, Jeong H, Park Y, Laparoscopic vaginal vault clo- sure with conventional straight instruments in single-port access total laparoscopic hysterectomy. Obstet Gynecol Sci 2013; 56 :389-399.
Kluivers KB, Johnson NP, Chien P, Vierhout ME, Bongers MY, Mol BW, Comparison of laparoscopic and abdominal hysterectomy in terms of quality of life: A systematic review. Eur J Obstet Gynecol Reprod Biol 2008;136:3–8.
Krishnakumar S, Tambe P, Entry Complications in Laparoscopic Surgery. J Gynecological Endoscopy and Surgery. 2009;1:4-11.4
Varma R, Gupta JK, Laparoscopic entry techniques: clinical guideli- ne, national survey,and medicolegal ramifications. Surg Endosc 2008; 22:2686–2697.
Tinelli A, Malvasi A, Istre O, Keckstein J, Stark M, Mettler L, Abdominal access in gynaecological laparoscopy: a comparison between direct optical and blind closed access by Verres needle. European Journal of Obstetrics & Gynecology and Reproductive Biology 2010; 148:191–194.
Rosnay P, Chandiramani M, Usman S, Owen E, Injury of epigastric ves- sels at laparoscopy: diagnosis and management. Gynecol Surg 2011; 8:353–356.
Paya K, Wurm J,Fakhari M, Puig RF, Puig S, Trocar-site hernia as a typical postoperative complication of minimally invasive surgery among pres- chool children. Surg Endosc 2008; 22: 2724–2727.
Ott J, Lansky AJ Poschalko G, Promberger, Rothschedl E,Wenzl R, Entry techniques in gynecologic laparoscopy—a Review. Gynecol Surg 2012; 9: 139–146.