Share a literature about visual puncture.

Background
There is a certain inherent risk after making air -stitches during laparoscopic surgery, which may cause damage to blood vessels and tissue. Open surgery will cause leakage of carbon dioxide and waste time. Another way is to use the visual spurs to create a channel, so that the entire process of puncture can be observed on the display. The purpose of this study is to explore whether the visual puncturers can be used in laparoscopic surgery to perform surgery safer and faster.

Method
This study lasted for 4 years, and a total of 650 laparoscopic surgery was performed using a visual puncture. These include gallbladder slicing (n = 282), groin hernia repository (n = 76), liver ** sorting (n = 73), adrenal resection (n = 54), appendix resection (n = 41) , Colon surgery (n = 39), and other surgery (n = 85). Record the specific indicators in each surgery: whether the patient had undergone surgery, the site of the surgery, the time required for puncture, and postoperative complications.

Result
In 650 surgery, 156 patients (24%) were performed before abdominal surgery. Among 25 surgery, the visual puncture was required to be punctured in the position of the previous surgery. 495 patients (76%) need to use the visual puncture device and then pests, 77 patients (12%) are punctured in the right upper abdomen, 26 patients (4%) are punctured in the left upper abdomen, 8 patients (1 1 patient (1 %) Pinged above the umbilicus, six patients (0.9%) were punctured in the right lower abdomen, and three patients (0.5%) were punctured on the left lower abdomen.

The average time in the umbilical puncture is 92s, and the incidence of complications is 0.3%, including: bowel injury and gallbladder damage, but immediately obtained ** and repair.

In Conclusion
It can be seen that visual puncture is safer and reducing the risk of surgery. It is a new trend for laparoscopic surgery.

Spelling principles and skills
Stranging needle is perpendicular to the abdominal wall, entering the pelvic cavity at a short distance, avoiding puncture needles to enter the abdominal cavity in the inside of the abdominal wall for a while, and the puncture needle should be entered vertically by the abdominal mirror monitoring. At that time, change direction towards the pelvic cavity into the spiral end into the abdominal cavity. (As shown below)

Three degrees of puncture
The angle on the mid -line: Poch vertically with the skin, try not to become an angle
Left and right angle: 0 left and right angles, that is, the puncture needle cannot deviate from the central axis, otherwise it will damage the total iliac blood vessels.
Strong: Power is the guarantee of successful puncture, and also cause damage factors. When puncture, it should be moderate to ensure that the puncture needle can be collected in any place.