磁锚定技术辅助减戳孔腹腔镜附件切除的实验研究

Experimental study of magnetic anchoring technique assisting trocar-less laparoscopic adnexectomy

目的:设计并加工用于减戳孔腹腔镜附件切除的磁锚定装置,并通过动物实验验证其可行性及安全性。方法:以8只雌性健康Beagle犬为动物模型,利用自行设计加工的磁锚定装置完成减戳孔腹腔镜附件切除,经肚脐穿刺建立气腹,于肚脐稍偏左建立戳孔,插入10 mm戳卡(trocar)进镜探查。于左下腹部建立戳孔,插入12 mm戳卡作为操作孔。经操作孔置入磁锚定装置的内置抓钳并钳夹右侧输卵管合适位置进行手术操作。观察分析8只Beagle犬手术时间和术中出血量,验证其可行性及安全性。结果:成功设计并加工可用于减戳孔腹腔镜附件切除的磁锚定装置,并利用该装置顺利经12 mm的戳卡置入Beagle犬动物模型腹腔,内置抓钳夹持组织操作简单方便。术中8只Beagle犬手术时间14~21 min,平均手术时间(17.5±3.5)min;术中出血量均<10 ml,平均出血量(7±2)ml;利用磁锚定装置实现了术野充分暴露,术中无磁体滑脱、组织撕伤及出血等损伤。结论:利用磁锚定装置可实现减戳孔腹腔镜附件切除安全可行,进一步优化该装置后可用于临床。

Objective:To design and process a magnetic anchoring device that can be applied to the trocar-less laparoscopic adnexectomy,and to verify its feasibility and safety through animal experiments.Methods:Eight healthy female Beagle dogs were used as animal model,and the self-designed and self-processed magnetic anchoring device was used to complete the trocar-less laparoscopic adnexectomy.Pneumoperitoneum was established by the puncture from navel,and a puncture was established on the slightly left of navel and a 10 mm trocar was inserted for exploration with microscope.And a puncture was established in the left lower abdomen and a 12 mm trocar was inserted as operation hole.The built-in grasping forceps of the magnetic anchoring device was inserted through the operation hole and it clamped the appropriate position of right fallopian tube for operation.The operation time and intraoperative bleeding amount of 8 Beagle dogs were observed and analyzed,and the feasibility and safety of this method were further verified.Results:The magnetic anchoring device that could be applied to the trocar-less laparoscopic adnexectomy was successfully designed and processed.And this device was successfully applied to insert laparoscope in the abdominal cavity of Beagle dog of animal model by 12 mm trocar.And the built-in grasping forceps could simply and conveniently clamp tissue.The range of operation times of the 8 Beagle dogs was from 14 to 21 min,and the average time was(17.5±3.5)min,and the amount of intraoperative bleeding of them was less than 10 mL,and the average amount was(7±2)mL.The magnetic anchoring device achieved the surgery field was fully exposed,and the general problems such as separation of magnetic body,tissue laceration and bleeding didn’t occur in operation process.Conclusion:It is safe and feasible to achieve the trocar-less laparoscopic adnexectomy by utilizing the magnetic anchor device,and the device can be ready for the clinical surgery after further optimization.