نام وسیله : تروکار Versa step
توضیح : نوعی تروکار با سیستم گشاد کننده شعاعی است که شامل قسمت های زیر می باشد :
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مش اسلیو ( mesh sleeve ) ،یک سوزن اینسوفلیشن ،
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یک ابتراتور بانوک بلانت
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یک شیت
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یک شیر سه راهه
برای مشاهده ی صفحه ی اینستاگرام ما می توانید بر روی این لینک کلیک نمایید.
با گذشت زمان ، تغییرات زیادی در ساخت تروکارها صورت گرفته است .
مورد استفاده : جهت ایجاد مسیری جهت ورود اندوسکوپ و سایر ابزارها از طریق کانولا به درون بدن ، کاربرد دارد .
توضیحات بیشتر : بعد از ایجاد پنوموپریتوئن ( ورود گاز co2 به درون حفره پریتوئن ) ، یک انسزیون کوچک در محل ورود پورت زده می شود . مش اسلیو بر روی سوزن قرار می گیرد و به درون پریتوئن هدایت می گردد . بعد از خارج کردن سوزن ، ابتراتور با نوک بلانت را به درون شیت وارد کرده و به درون پریتوئن هدایت می گردد .
ابتراتور خارج می گردد و شیت ( غلاف ) در سر جای خود باقی می ماند تا از طریق آن بتوان ابزار ها را به درون بدن وارد نمود .
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VersaStep™Plus Access System
Abstract
Use of the VersaStep trocar system (US Surgical, Norwalk, CT) has the perceived advantage of minimal trocar-related hernias in patients undergoing Roux-en-Y gastric bypass surgery (RYGB).
We performed a retrospective review of our last 747 consecutive operative procedures using these trocars.
The patient population was 747 consecutive patients who underwent laparoscopic RYGB at Duke University Health System Weight Loss Surgery Center from January 2002 through April 2005.
A total of 3735 radially expanded trocar sites were used. VersaStep trocars were used in all cases.
The port configuration included one supraumbilical Hasson port, two 12-mm ports, and three 5-mm ports.
The Hasson port was closed with a figure-of-eight number 1 Polysorb suture. All other trocar sites had no fascial closure.
Intestinal anastomoses were created with a linear stapler in all of the laparoscopic cases, with hand suturing of the residual enterotomy.
The fascial incisions were therefore not extended to accommodate an EEA stapler. The charts were reviewed for occurrence of subsequent trocar site hernias.
There were no hernias at any of the VersaStep trocar sites-an incidence of 0%. There were nine incisional hernias at the Hasson port site which later required surgical repair-an incidence of 1.20%.
There were no hernias detected at any of the 1494 12-mm or 2241 5-mm VersaStep trocar sites, despite lack of suture closure.
At the Hasson port site, there was a hernia incidence of 1.20%. In the bariatric RYGB population, routine suture closure of the fascia or muscle is not necessary when using radially expanding VersaStep trocars.
VersaStep™ Plus access system has reduced significant complications that can occur in laparoscopic surgery Multiple studies have substantiated that the following improved outcomes have been obtained using the VersaStep™ Plus access system when compared to conventional cutting trocars:∙
Decreased incidence of major vascular injury1∙Decreased incidence of bowel/bladder injury2∙
Decreased incidence of abdominal wall bleeding3∙
Decreased incidence of post operative incisional hernia4In addition:∙A substantial number of patients report less pain when VersaStep™ Plus access system entry ports are used5∙VersaStep™ Plus access system is selfanchoring and may reduce the need for fascial closure6∙The use of VersaStep™ Plus
access system may reduce procedure time .
VersaStep™ Plus access system needle/sleeve insertion reduces entry profile
VersaStep™ Plus access system uses a proprietary radially expanding sleeve with needle to initiate the port entry.
Conventional trocars, on the other hand, rely upon a metal or plastic cutting tip to penetrate the abdominal wall.The cutting profile of a conventional trocar can be as large as 12.2 mm depending on the size of the port required.
With VersaStep™ Plus access system, regardless of the port size, entry is accomplished by dilating a tract established by a needle/sleeve assembly with a cross sectional profile of 2.1 mm
VersaSeal™ Plus single use seal minimizes the potential of tears and leakage
The VersaSeal™Plus single use seal provides hands-free exchange of instruments ranging from 4.5 mm to 12 mm without external converters.
The blue seal is extremely durable minimising the potential of tears or leakage during instrument insertion or manipulation.
VersaStep™ Plus instrument gridiron incisions leave smaller residual defects
Radial dilation separates and stretches the tissue and muscle layers along natural anatomic planes making smaller, slit-like wounds.
When the VersaStep™ Plus instrument cannula is removed, the defects in each layer contract leaving a series of non-overlapping slits that resemble a grid-iron incision.
The width of the residual VersaStep™ Plus instrument defect is approximately one half the size of the stellate wound left behind by conventional trocars.Based on their own clinical experience, surgeons have chosen not to routinely close fascial wounds from 10 mm and 12 mm VersaStep™ Plus instrument port sites .
VersaStep™ Plus instrument is not a sharp cutting trocar
VersaStep™ Plus instrument is not a sharp cutting trocarConventional trocars can cut or tear tissue (vascular, non-vascular, fascial, muscular).Trocars require substantial axial force to penetrate the abdominal wall.
Axial force is required to thrust a bladed or tapered cutting device downward through tissues which may cause one or all of the following: tenting of abdominal wall tissue, severing of blood vessels, displacement/disruption of the tissue and incisional tissue trauma.
With VersaStep™ Plus instrument, the initial needle tract is radially expanded, and tissues are stretched not cut.
This effectively tamponades blood vessels, firmly anchors the cannula in place, enables easy expansion of access ports to larger sizes, and leaves slit-like wounds that are approximately half the size of those created by comparably sized trocars .
VersaStep™ Plus instrument is self-anchoringRadial
traction helps to prevent cannula displacement.Conventional trocars, especially those used as operating ports, frequently become dislodged. This is particularly true during long procedures, resulting in loss of pneumoperitoneum.
Repositioning displaced trocars requires re-entry of a sharp trocar and reinsufflation of the abdomen, which is time consuming Radially expanding dilation results in stretching and compression of tissue
fixing the VersaStep™ Plus instrument cannula securely to the abdominal wall.
This self-anchoring feature virtually eliminates the likelihood of port displacement and re-entry of another sharp device. Rarely, if ever, does slippage occur with VersaStep™ Plus instrument.
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