Speaking of laparoscopic surgery, surgical operations are usually performed in the patient cavity through 2-4 small incisions of about 1 cm. The main purpose of disposable trocars in laparoscopic surgery is to penetrate the entire layer of the abdominal wall to establish a connection between the outside world and the abdominal cavity. The channel allows surgical instruments to enter the abdominal cavity through the trocar sleeve to complete the surgical process.
Choose different specifications of trocar cannula
The disposable trocar is composed of two parts, the trocar cannula and the trocar obturator.
Choose different specifications of trocar cannula.
The 5mm and 10mm puncture cannulas are the two most commonly used specifications in gynecological laparoscopic surgery. Most of the operating instruments, such as separating forceps, scissors, coagulation hooks, needle holders and other configuration instruments, are all 5mm in diameter.
The 15mm puncture cannula is generally only used for uterine tumor removal or surgery that needs to crush the uterus.
Select the number of trocar devices and puncture position
Different surgeries choose different numbers of trocars, and the positions of incisions are different.
A. Two are suitable for type I~II surgery, including auxiliary vaginal hysterectomy. If it is a single-hand operation, it can also be used for type III surgery, such as uterine fibroids, simple hysterectomy and other operations.
For the first auxiliary puncture hole, choose a 10mm cannula. The puncture point is located on the left side (the position of the main surgeon). Under the photo, grasp the trocar with your right hand, and slowly push the trocar into the abdominal cavity with thenar muscle and palm strength. When the tapered trocar penetrates the peritoneum, it is inclined to the center of the pelvis to avoid damage to the intestine. The second auxiliary puncture hole is selected on the right side of the patient (the position of the assistant), which is symmetrical to the position of the first auxiliary puncture hole. Choose a 5mm trocar.
B. 3 are mainly suitable for two-person operation of intramural myomectomy, various surgical hysterectomy except LAVH, and complicated pelvic surgery.
On the basis of the two auxiliary punctures, the upper edge of the symphysis pubis is 2 cm, and the median line is 2-3 cm on the left side. After the skin is cut, a 5 mm trocar is used. The puncture direction is obliquely to the outside, and the tapered needle should enter the abdominal cavity on the outside of the umbilical ligament.
C. 4 are rarely used, and are generally used for radical malignant tumors of the uterus.
On the basis of the three auxiliary punctures, a 5mm trocar was selected on the right side of the pubic symphysis corresponding to the left side.
Selected from "Practical Gynecology Laparoscopic Surgery"
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