Before starting laparoscopic surgery, it is necessary to enter the abdominal cavity and establish a channel. The Hasson method is currently the standard puncture insertion method for laparoscopic surgery.
1.Hasson puncture method
The Hasson method is currently the standard Trocar insertion method in laparoscopic surgery. It requires the abdominal wall structure to be opened and separated layer by layer under an open field of view until the peritoneal cavity space is reached, and then the cannula (Hasson port) is inserted.
The process of opening the abdominal wall structure with the Hasson puncture method is clearly visible and avoids the risk of damaging the internal organs in the abdominal cavity. Because the layer-by-layer separation can be done at will, local bleeding can be treated in a timely manner. Therefore, it is also the best way to deal with bleeding among all puncture methods. method.
2. Puncture operation
Make a 10 to 12 mm long longitudinal, transverse, or arc-shaped skin incision at the lower or upper edge of the umbilicus. The choice of incision location can be based on the surgeon's preference or consideration of adhesions at previous incisions. Use a narrow retractor or Kelly hemostat to bluntly separate the subcutaneous fat and tissue. After seeing the abdominal white line, use the hemostat to clamp both sides of it and lift it upward to make a 10 mm vertical incision. Continue to separate with hemostatic forceps. The white and thick peritoneum can be seen. Use a pair of hemostatic forceps to grasp both sides of the peritoneum and lift it upward. Use a scalpel to carefully open the peritoneum. The black and empty abdominal cavity can be seen. Place a suture on both sides of the incision. The traction wire is used to pull the peritoneum and the linea alba and subsequently to fix the Hasson sheath.
Next, it is necessary to confirm whether the abdominal cavity has been successfully entered. The surgeon inserts his little finger into the incision. This action can verify whether the opening is large enough to insert the sheath and at the same time feel the local condition. Usually the peritoneum in this area is free, but occasionally there may be some thin omental adhesions, which can be pushed away by hand. Insert the Hasson sheath with a blunt inner core into the abdominal cavity, screw the spiral cannula into the fascia to prevent air leakage, and then fix the preset sutures on both sides to the grooves on both sides of the cannula. Then pull out the inner core, connect the gas injection tube, turn on the switch, and set the gas flow rate and maximum pressure (15 mmHg, elderly patients should lower it appropriately). As the abdominal wall bulges, the intra-abdominal pressure and the total amount of air injected are observed.
If there are omental adhesions and a thick falciform ligament, the lens may not pass smoothly into the abdominal cavity through the end of the Hasson sheath. If the surgeon has previously touched this area with his little finger and found no abnormal findings, the correct approach can usually be found by rotating and adjusting the lens angle. If the entrance cannot be found, the casing should be pulled out, re-explored and then inserted again. In rare cases, due to dense adhesions, if a feasible approach cannot be found by finger exploration, the position where the Hasson sheath is inserted should be changed.
