Trocar puncture
1. Place a laparoscopic sleeve
Laparoscopic puncture cannula is the first cannula that enters the abdominal cavity of the human, mainly blind puncture. According to the diameter of the lens body, a 5mm or 10mm trocar can be used. When the pneumoperitoneum pressure reached 15mmHg, the pneumoperitoneum needle was pulled out, and a trocar was inserted at the original puncture point. Specific operation: Raise the abdominal wall with towel forceps, hold the trocar in the right hand, clamp the cannula with the index finger and middle finger, and place the fish muscle on the top of the trocar. Rotate the trocar slowly with palm power. It is very important not to use violence or physical strength. Because this puncture point is blind, 50% of the complications of laparoscopic surgery are caused by it. Blood vessels. During the puncture, the trocar can be perpendicular to the skin or slightly inclined to the abdomen. Once it enters the human abdominal cavity, the resistance decreases when the right hand rotates, and the puncture can be stopped. Pull out the core of the trocar, open the valve switch on the trocar, and hear the puff of gas overflow, indicating that the trocar has entered the abdominal cavity. Close the valve, connect the laparoscopic lens body to the cold light source and the camera system, slowly insert the person through the sheath sheath, and observe while pushing the mirror to confirm that the sheath sheath is fully inserted into the human abdominal cavity, connect the inflation catheter, open the valve, and continue to inflate to Pneumoperitoneum pressure stabilized at 15mmHg. If the cannula sheath does not enter the human abdomen, withdraw the scope and reinsert the puncture trocar to rotate the needle until the cannula sheath completely breaks through the peritoneum and enters the human abdomen under the laparoscope.
2. Insert working sleeve
Choose different sizes of cannulas according to surgical needs. Most of the operating instruments are 5mm in diameter and a few are 10mm, so 5mm or 10mm casings are often used. When using a 5mm instrument through a larger cannula, a corresponding converter can be used. The conventional choice of the left and right lower abdomen is equivalent to the second and third puncture points at the Mai's point. If necessary, the fourth point puncture is performed at the mid-distance of the lower abdomen and the three transverse fingers of the upper edge of the pubic symphysis. Under laparoscopic transillumination, the skin was incised 1 cm in the avascular area. Under laparoscopic monitoring, grasp the trocar with your right hand, and slowly push the trocar toward the abdominal cavity with the intero fish muscle and palm force. When the trocar penetrates the peritoneum, tilt the needle to the center of the pelvis to avoid damaging the intestinal canal.
