What Is a Laparoscopic Trocar?

Laparoscopy is similar to electronic gastroscopy. It is a medical device with a miniature camera. Laparoscopy is a procedure performed using laparoscopy and related equipment.

Chinese name: Laparoscopy
Foreign name: Laparoscope

Management category: Class III medical devices
Category Name: Cardiac and vascular endoscopic endoscopy

Basic composition of laparoscopy

The five basic systems consist of a laparoscopic video surveillance system, a CO ₂ pneumoperitoneum system, an electric cutting system, an irrigation-suction system, and surgical instruments. As shown in Figure 1.

Figure 1 Schematic diagram of laparoscopy

Laparoscopic video surveillance system

It consists of a laparoscope, a light source and a light path, a micro camera, a video converter, a monitor (television), an automatic cold light source, and a video recorder. Laparoscopy is commonly used at 0 ° and 30 ° viewing angles. Various specifications of 10mm, 5mm, 2.5mm. as shown in picture 2.

Figure 2 Laparoscopic video surveillance system

CO ₂ pneumoperitoneum system

It consists of a spring pneumoperitoneum needle (Veness needle), an inflatable catheter, a pneumoperitoneum machine and a CO ₂ cylinder. The purpose is to provide a wide space and field of vision for surgery.

The intra-abdominal pressure required for scheduled surgery is 12-15mmHg and automatic pneumoperitoneum.

3. Flush-absorption system

It consists of two parts:

1) Rinse: observe and protect tissues, prevent adhesions, stop bleeding, repair tissues, etc.

2) Attraction: Use the catheter effect to attract, and sometimes use a filter.

4. Surgical Instrument System

Basic cholecystectomy instruments: 2 10mm trocars, 2 5mm trocars, 1 10mm instrument converter, 2 non-invasive grasping forceps, 1 curved dissecting forceps, pneumoperitoneum needle, scissors, titanium clip Pliers, flushing-suction tube, electrocoagulation separation shovel, separation hook each.

Special equipment: angiography contrast tube, needle holder forceps, snare needles and snares for ligation, netting, etc.

Clinical application of laparoscopy

Surgery

1) General surgery: cholecystectomy, hepatic cystic drainage, intestinal adhesion release, splenectomy, hernia repair, gastrointestinal surgery.

2) Urology: Opening of renal cyst and adrenal tumor resection.

3) Obstetrics and Gynecology: Ectopic pregnancy resection, uterine fibroids, total hysterectomy.

4) Thoracic surgery: bullae resection, spontaneous hemopneumothorax to stop bleeding.

2. Diagnosis

1) Direct biopsy, excisional biopsy, and ultrasound localization.

2) Unexplained chronic abdominal pain.

3) Qualitative and staging of abdominal tumors.

4) Differential diagnosis of liver disease and ascites.

5) Lymph biopsy.

6) Non-traumatic examinations are difficult to diagnose.

Laparoscopic laparoscopic operation method

Artificial pneumoperitoneum

Cut the skin 1cm from the lower edge of the umbilical wheel, insert the pneumoperitoneum needle at 45 degrees from the incision, draw a bloodless tube, and then connect a needle tube. If normal saline flows in, the puncture is successful and the needle is in the abdominal cavity. When connected to a CO ₂ inflator, the air intake speed should not exceed 1L / min, and the total amount is preferably 2-3L. The pressure in the abdominal cavity does not exceed 2.13KPa (16mmHg).

Trocar puncture

The laparoscope needs to be inserted into the abdominal cavity from the cannula, and a trocar needs to be inserted first. The laparoscopic cannula is thick and the incision should be 1.5cm. Lift the abdominal wall below the umbilical cord, insert the trocar obliquely and slowly into the abdominal cavity first. There is a sense of breakthrough when entering the abdominal cavity. Pull out the cannula core, insert the laparoscope after hearing the sound of gas in the abdominal cavity, switch on the light source, and adjust the patient. Posture into the head low hips 15 degrees, and continue to slowly inflate.

3. Laparoscopy

The surgeon held a laparoscope and eyepieces to observe the uterus and various ligaments, ovaries and fallopian tubes, and rectal uterine depression. During observation, the assistant can move the uterine device to change the position of the uterus to cooperate with the examination. If necessary, the suspected lesion tissue can be taken for pathological examination.

4. Remove the laparoscope

Check that there is no internal bleeding and organ damage before removing the laparoscope. After venting the gas in the abdominal cavity, remove the cannula, suture the abdominal incision, and cover it with sterile gauze and tape.

Laparoscopy after laparoscopy

1. Give antibiotics to prevent infection.

2. Although vented before suture the abdominal incision, there may still be residual gas in the abdominal cavity and shoulder pain and discomfort in the upper abdomen, which is usually not serious and does not require special treatment.

Laparoscopic precautions after laparoscopy

Laparoscopic surgery should pay attention to consolidating the effect of the operation and restore physical strength as soon as possible. To do the following:

1. Within 6 hours after surgery, use a pillow-recumbent position with the head sideways to prevent vomit from being drawn into the trachea.

2. Although most patients have no pain after surgery, do not neglect to massage the patient's waist and legs, and turn over the patient half an hour to promote blood circulation and prevent bedsores.

3. After the fluid is infused on the day, the urinary tube can be pulled out to encourage patients to get out of bed.

4. Patients can have a small amount of liquid diet, such as dilute rice soup and noodle soup, within 6 hours after surgery. Do not give patients sugary drinks such as sweet milk and soy milk powder.

5. The laparoscopic surgical incision is only 1 cm, so the abdominal dressing can be removed after a week, and you can take a shower, and then you can gradually resume normal activities. One week ago, we should pay attention to proper and light activities to restore the body as soon as possible.

Features and advantages and disadvantages of laparoscopic laparoscopic surgery

Characteristics

1) Multi-angle "inspection" with intuitive effect

Laparoscopy can be examined from different angles and directions without involving the abdominal organs, and it can even see some deep locations to achieve the effect of intuitive inspection without missed diagnosis or misdiagnosis.

2) Fast recovery

The operation was performed in a closed pelvis and abdominal cavity, and the internal environment was less disturbed. The patient suffered much less trauma than open surgery, and he recovered quickly after surgery without complications and sequelae.

3) Short hospital stay

The operation is performed by a professional physician, and the treatment can be completed in a short time without affecting normal physiological functions, and normal life and work can be resumed after surgery.

4) Good abdominal beauty

Conventional surgery with a moving knife will leave a very ugly scar on the body, but there is no such problem in abdominal surgery, and women can do this without any care.

5) Less pelvic adhesions

Minimally invasive technology, no need for surgery, less interference to the pelvic cavity, no gauze and hand-to-tissue contact, and few or no sutures. The pelvic cavity is sufficiently flushed during the operation, so the patient's pelvic adhesion after laparoscopic surgery is much less than that of open surgery.

2. Compared with traditional surgery, it has the following advantages

1) Laparoscopic surgery has less disturbance to the internal organs of the abdominal cavity, avoiding the irritation and pollution of the abdominal cavity by air and dust bacteria in the air. During the operation, electrotomy and electrocoagulation are the main operations. The blood vessels are coagulated first and then severed. The hemostasis is thorough and the bleeding is very small. Thoroughly rinse before the end of the operation to keep the abdominal cavity clean. Therefore, intestinal function recovers quickly after surgery, and food can be eaten earlier, which greatly reduces the incidence of postoperative intestinal adhesions.

2) Laparoscopic surgery is the representative of truly minimally invasive surgery, with greatly reduced trauma, less pain and ease during the surgical process and postoperative recovery.

3) The patient can get out of bed early after operation and the sleeping position is relatively casual, which greatly reduces the intensity of family care.

4) The piercing holes in the abdominal wall are small (ranging from 3-10mm), scattered and concealed, and the appearance is not affected after healing.

5) General anesthesia is generally used, and various monitoring is complete, and the safety is greatly increased.

6) Poked hole infections are far less than traditional incision infections or fat liquefaction.

7) The puncture of the abdominal wall replaces the abdominal wall incision, avoiding the damage of abdominal wall muscles, blood vessels and corresponding nerves. Postoperative abdominal wall weakness and abdominal wall incision hernia will not appear. It will not affect motor function due to abdominal wall muscle scarring, and will not cause abdominal wall nerves. Cutting off causes corresponding skin numbness.

Disadvantage

1) Laparoscopic equipment is expensive and complicated to operate. Laparoscopic surgery retraining is required, and there are technical requirements for the surgeon.

2) It is difficult to estimate the operation time before surgery. In special cases, it is necessary to switch to open surgery during surgery.

3) Laparoscopic surgery increases the risk of surgery in special cases ^[1] .

Laparoscopic common faults and maintenance measures

Pneumoperitoneum system failure and maintenance measures

1) Pressure display error: If there are multiple sensors operating in a group at the same time, as long as one sensor is contaminated or aged, the entire group of sensors must be replaced.

2) Flow display error: If the flow sensor is damaged, it must be replaced. If it is calculated from the differential pressure, the differential pressure sensor needs to be replaced.

3) Pneumoperitoneum leak: The cause may be that the carbon dioxide cylinder is empty or the air valve is leaking. It should be replaced at this time. If the Hasson cannula fixation is loose, the suture should be tightened or re-stitched.

2. Imaging system failure and maintenance measures

1) Image interference: Generally, when high-frequency equipment is used, interference lines are prone to occur. It is necessary to check the connectivity between the camera and the shielded line. If the camera is not firmly connected, it should be re-soldered; if the wire body is aging, it should be replaced in time.

2) Image color cast: first consider the white balance and supporting equipment. If neither is the case, consider whether the signal transmission due to aging of the wires is poor or the camera line is aging.

3. Power system failure and maintenance measures

Common faults are wear of the cutter head and failure of the high-energy motor of the handle. However, not every motor can replace accessories. Therefore, you should selectively replace the motor, pay attention to maintenance and maintenance in daily use, and try to avoid failure. In addition, according to the severity of the fault, the cutter head is selectively replaced to ensure the normal operation of the equipment.

4. Flushing system failure and maintenance measures

The common failure is that the machine cannot be turned on, mainly because the liquid enters the system equipment. If the accessories are not burned out, just clean the liquid in time. In addition, the lack of pressure and suction is also a more common type of failure, which may be caused by aging of the motor and leakage of the ventilation valve. Therefore, the motor should be selectively replaced to prevent leakage of the ventilation valve ^[1] ^[2] .

Laparoscopic Extended Reading

[1] Zhao Jing. Brief introduction of laparoscopic instrument management and instrument cleaning and maintenance [A]. Chinese Nursing Association. The 12th National Conference of Operating Room Nursing Academic Exchange and Special Lecture Conference Compilation (2) [C]. Chinese Nursing Association: 2008: 2.

[2] Tan Jing. Laparoscopic Equipment Composition and Failure Maintenance [J]. Medical Equipment, 2007 (09): 48-49.