Method to assist trocar insertion during surgery

摘要

A method of identifying a position at which an opening can be made in the peritoneum of an anaesthetised patient to enable the insertion of a laparoscopic tool to assist in laparoscopic surgery after an initial umbilical opening has been made. The method involves the steps of: inflating the abdomen via the umbilical opening or otherwise lifting the abdomen, selecting an elongate tool having a trocar support ring ( 1 ) at its leading end, introducing the ring ahead of the tool through the umbilical opening, and pushing the tool in a forward sense so as to press the ring against the peritoneum to deform and locally stretch the skin, and thereafter viewing the deformation externally. The pointed end of a trocar is then positioned centrally of the deformation of the abdominal wall and forced through the area of stretched skin so that the tip of the trocar penetrates the skin and is received in the support ring. An elongate tool for use in the method includes a loop or ring which extends from one end of the tool with its plane non-parallel to the axis of the tool. The loop or ring and the body of the tool are substantially rigid and non-deformable to allow the loop or ring to be pushed into contact with the internal abdomen wall and to stretch the skin of the wall to form an externally visible taut area of skin. The size of the loop or ring is selected so that it is to small to allow the trocar to pass completely therethrough, and optionally a cage or cup is located to the rear of the loop or ring to receive the leading end of a trocar thereby to prevent the trocar point from penetrating an internal organ. The loop or ring is discontinuous and defines a U or C shape.