Volume 27, Issue 12 (3-2021)                   RJMS 2021, 27(12): 1-9 | Back to browse issues page

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Haghgoo A. Introduction of a new modified trocar insertion method (Amen method) according to the findings of its comparison with the direct laparoscopic method of laparoscopy. RJMS 2021; 27 (12) :1-9
URL: http://rjms.iums.ac.ir/article-1-6426-en.html
Iran University of Medical Sciences, Tehran, Iran , mnhaghgoo@yahoo.com
Abstract:   (1936 Views)
Background & Aims: Over the last decade, Laparoscopy is one of the most common operations performed in gynecologic surgery. Various methods have been described in literatures such as Veress needle, open access technique (OAT), direct trocar insertion (DTI), and visible entry method which can potentially cause visceral and vascular injury. It is estimated that most laparoscopic injuries occur at the time of trocar insertion. Although the complications of operative laparoscopy are in low rate, they can be severe and life threatened, so preventing the complications associated with initial abdominal entry is a primary concern for laparoscopic surgeons. A detailed well-training trocar insertion method such as Amen method in the present study, may lead to better patient’s safety and less complication in shorter time. To the best of our knowledge this initial trocar insertion method (Amen) in laparoscopy has not been introduced yet. This method could learned easily and surgeons could use any available instrument for trocar insertion. The aim of the present study is to compare the two methods of novel modified towel insertion method (Amen) and direct method, in terms of its complications and initial trocar time insertion, to provide and suggest new trocar insertion method (Amen) for surgeons.
Methods: A prospective case-control study conducted at Nikan hospital between December 2018 and March 2020.Four hundred four patients who underwent either new modified towel clip trocar insertion (Amen) method or direct entry approach in laparoscopic surgery. Participants were randomized to two groups of modified towel clip (Amen) (214) and direct trocar insertion methods (190), respectively. All method-related complications consisted of port site gas leakage, port site emphysema, intra-abdominal vascular injury, port site hematoma, port site infection, port site hernia were assessed. Although there is a significant statistical relationship between gas leakage and trocar technique in favor of control groups, the rate of other complications were the same in both groups which are not seen in both groups. In addition, port site emphysema in control group is less than the case group, however it is not statistically significant.
Inclusion criteria were all patients who are candidates for gynecologic laparoscopic surgery. Firstly, 419 patients entered to study, however 11 patients who underwent both methods and 3 with palmers point insertion method were excluded from the study. Also, the trocar insertion method was failed in seven participants therefore direct method changed to modified one due to the following reason: three of them had high BMI (>38) and trocar was short for them, 3 patients had strong fascia and trocar was not sharp, so after 3 click and 2 times, insertion were failed, also in one patient with Sub-umbilical mesh due to the history of abdominoplasty and hernia, trocar insertion failed. Four patients had high BMI more than 38, so the Amen method changed to direct method. Therefore 14 patients were excluded from the study. Port site gas leakage, port site emphysema, intra-abdominal vascular injury, port site hematoma, port site infection and port site hernia were evaluated and compared in two methods of trocar insertion method in this investigation. Spss version 20, Independent T test and chi-square were used for performing analysis and P-value less than 0.05 was estimated as a significant difference.
Results: In a total of 404 female patients with the range age of 15 to 65 years, there is no significant difference in terms of port site emphysema complication between case and control group. Although there is significant relationship between trocar technique and gas leakage complication (p=0.007), there is no other complication such as Intra-abdominal vascular injury, port site hematoma, infection and bleeding in both groups of case and control group. Although, the direct method is significantly less time consuming than Amen method (p=0.04), majority of initial trocar time insertion method in both case and control group was less than 1 minute Also, the size of scar and incision in the present technique is the same as the direct method (11-12 mm) which is smaller than open method that are previously reported,which can be significant in terms of beauty and less pain at the scar site.
The most common type of surgery in case group (Amen method) was endometriosis (51.9%), and then hysterectomy (12.5%). Similarly, the most common type of surgery in control group (direct method) was endometriosis (41.5%) and then endometriosis accompanied with hysterectomy (16%).
Conclusion: The present data suggest that the incidence of complications in our new method is as much as direct method except for gas leakage. In addition, there is an advantage to apply the Amen method since it takes short time for trocar insertion. Furthermore this technique could be trained more easily than other previous trocar insertion methods. In addition, Amen method performed with any available trocar which could be salient in surgery. Therefore, we concluded that Amen technique is safe, reliable and easily trainable modified entry method which could be alternatively used instead of direct method for laparoscopic surgery.
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Type of Study: Research | Subject: Gynecology

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