https://en.wikipedia.org/wiki/Veress_needle

Cia peb pib nrog qhov tseeb counterintuitive. CovVeress koob(pneumoperitoneum koob) zoo nkaus li tsis muaj dab tsi ntau tshaj li cov koob txhaj tshuaj txuas ntxiv -80 txog 150 mm ntev, nrog rau sab nraud ntawm li 2 hli, yog li slender hauv xib teg uas nws xav tias yuav luag tsis hnyav. Txawm li cas los xij, hauv thawj thib ob ntawm kev phais laparoscopic, nws dhau los ua "tus neeg saib xyuas" rau tag nrho cov txheej txheem. Yog tias qhov kev nkag mus no tsis zoo, sib sib zog nqus dhau, lossis tsis nyob hauv nruab nrab, tag nrho cov kev ua haujlwm tsis zoo tom ntej yuav raug tsim los ntawm lub hauv paus ntawm cov teeb meem.

Yog li, tus qauv ntawm Veress koob yeej tsis yooj yim li "ib koob hollow" - nws yog ib qho kev ruaj ntseg zoo uas tsim los ntawm plaub lub hauv nruab nrab hauv nruab nrab: lub plhaub sab nraud, lub hauv paus tseem ceeb, lub caij nplooj ntoos hlav, thiab lub valve.

Thawj Txheej: Sab Nraud Cannula - Lub Cutter, Kuj yog qhov chaw ntawm kev pheej hmoo

Lub plhaub sab nrauv yog cov qauv tubular ntawm txheej txheej sab nraud ntawm Veress rab koob, nrog lub ntsej muag beveled ntawm nws qhov kawg kawg -qhov tseem ceeb yog rab riam me me. Nws txoj haujlwm yog txhawm rau tiv thaiv los ntawm cov khaubncaws sab nraud povtseg ntawm lub plab phab ntsa (tawv nqaij → subcutaneous rog → fascia → peritoneum), tsim kom muaj ib txoj kev los ntawm kev txiav nrog tsawg kawg nkaus cross-sectional cheeb tsam.

Cov Qauv Tseem Ceeb Parameter:

Sab nraud txoj kab uas hla: Feem ntau 2.0-2.5 hli (kwv yees li 14-16 gauge), nrog 2 hli yog qhov feem ntau specification

Ntev: Peb qhov ntau thiab tsawg yog 80 hli, 120 hli, thiab 150 hli, nrog 120 hli yog tus qauv xaiv rau ob qho tib si gynecology thiab kev phais dav dav

Khoom siv: Kev kho mob- qib stainless hlau (feem ntau yog qib 316L), muab qhov sib npaug ntawm kev nruj (kom tiv thaiv kev khoov thaum sib tsoo) thiab tiv thaiv corrosion, nrog rau kev ua kom tsis muaj menyuam

Lub kaum sab xis ntawm ntug txiav txiav txim siab seb nws "txiav" lossis "pushes"- ib yam nkaus - lub kaum sab xis zoo li poking nrog lub khob hliav qab, ua rau cov ntaub so ntswg tseem ceeb; ib yam nkaus thiab- lub kaum sab xis ua rau muaj kev tiv thaiv zoo heev, yuam cov kws phais kom them nyiaj nrog lub dab teg txav thiab yog li ua rau muaj kev pheej hmoo ntawm kev tswj tsis tau. Lub plhaub sab nrauv zoo tsis yog hais txog kev ua kom ntse li qhov ua tau, tab sis qhov zoo li qhov hloov pauv ntawm cov hniav thiab cov phab ntsa, yog li ntawd thaum nws nkag mus rau lub fascia, nws muab qhov tseeb "pop" (kev nkag siab ntawm kev tso tawm), es tsis txhob blindly yuam nws txoj kev.

Lub zeem muag (distal) kawg ntawm lub tsho sab nrauv yog haum nrog tus qauv Luer xauv los yog xov txuas rau kev sib raug zoo nrog tus kov lub cev, rau kev txuas mus rau lub insufflator tubing.

Ob txheej txheej: Sab hauv Stylet / Obturator - Qhov Tseeb "Lub Neej-Txuag Cheeb Tsam"

Qhov no yog qhov tseem ceeb ntawm Veress koob, thiab nws tseem yog qhov tseem ceeb uas nws txawv ntawm ib rab koob zoo tib yam. Lub koob core yog ib tug hollow pas nrig thinner tshaj lub puab txoj kab uas hla ntawm lub txheej sheath:

Nthuav cov lus qhia ntawm qhov kawg ntawm qhov kawg- tsis txiav cov ntaub so ntswg, tab sis ua haujlwm rau chaw nyob thiab muab kev tiv thaiv

Lub qhov muag sab nraud (sab chaw nres nkoj) nyob ze ntawm qhov kawg ntawm tus ncej, kwv yees li 0.4 hli hauv txoj kab uas hla, tso cai rau CO₂ roj ntws los ntawm cov cannula sab hauv mus rau hauv lub plab kab noj hniav los ntawm qhov chaw nres nkoj sab, thaum tseem tiv thaiv occlusion thaum rab koob yog nias tawm tsam cov phab ntsa hauv plab los yog hauv nruab nrog cev.

Lub cannula sab hauv yog ob peb millimeters ntev dua li cov txheej txheem sab nraud-thaum pub dawb (tsis muaj kev sib txuas), lub ntsej muag blunt ib txwm nthuav tawm me ntsis dhau ntawm qhov distal bevel ntawm lub plhaub sab nraud

Yog li thaum so, cov lus qhia koj pom yog qhov tseeb "kev sib xyaw kawg qhwv ib ncig ntawm qhov tsis pom tseeb"; tsuas yog thaum lub sij hawm ntawm lub siab -induced puncture nws retract, exposing lub ntse beveled ntug ntawm lub sheath txheej los ua nws hauj lwm.

Qib Peb: Caij nplooj ntoos hlav Safety Mechanism - Mechanical Logic of "Automatic Yielding → Automatic Reset"

Lub tshuab caij nplooj ntoos hlav yog qhov tseem ceeb tshaj plaws ntawm kev nyab xeeb ntawm Veress koob: Lub hauv paus ntsiab lus ua haujlwm tuaj yeem piav qhia hauv ob kab lus, tab sis nws tseem ceeb heev hauv engineering.

Puncture theem (kab koob tseem nyob rau hauv lub plab phab ntsa): Tus kws kho mob nce lub koob ntxaum → lub plab phab ntsa exerts ib tug counterforce tawm tsam lub blunt puab core → lub puab tub ntxhais compresses lub caij nplooj ntoos hlav thiab retracts rau hauv lub txheej sheath → beveled ntug ntawm lub txheej sheath ua ntug → cov ntaub so ntswg.

Kev nkag mus rau theem (dhau los ntawm peritoneum mus rau hauv lub plab kab noj hniav): Resistance poob sharply → lub caij nplooj ntoos hlav tso nws lub peev xwm khaws cia lub zog → lub hauv paus ntsiab lus snaps sab nraud, thiab lub blunt taub hau ib zaug dua npog lub distal kawg ntawm lub puab sheath → ntawm no taw tes, qhov kawg ntawm lub koob nyob rau hauv lub plab mog ib ncig ntawm lub qhov ncauj kab noj hniav, uas yog ib qho yooj yim mus use. lub cev los yog omentum es tsis nkag mus rau lawv.

Lub zog calibrated ntawm lub caij nplooj ntoos hlav no feem ntau nyob nruab nrab ntawm 2 thiab 3 N, thiab yuav tsum ua tau raws li cov cai hauv qab no:

Txaus rhiab heev- tuaj yeem ua rau thim rov qab / xa tawm txawm tias nyob hauv cov neeg laus laus uas muaj phab ntsa hauv plab

ruaj khov heev- tsis ua rau qaug zog ntxov vim muaj kev vibrations tsheb thauj mus los lossis rov ua tshuaj tua kab mob

Kev mob stroke meej- tom qab xa tawm, lub ntsej muag blunt txuas ntxiv raws nraim 1.5-2.5 hli dhau ntawm ntug txheej txheej, muab kev tiv thaiv zoo

Lub caij nplooj ntoos hlav mechanism ntawm reusable (hlau) Veress koob yog detachable rau kev soj ntsuam, whereas pov tseg yas Veress koob encapsulate no mechanism nyob rau hauv ib tug molded kov, cia siab rau lub Hoobkas zoo tswj, thiab muab pov tseg tag nrho tom qab siv.

Plaub Txheej: Kov thiab Stopcock (Ntawm -Off Valve)

Cov seem tuav ua haujlwm raws li tib neeg - tshuab interface:

Grip cheeb tsam: Tus kws kho mob tuav lub koob ncej nrog peb ntiv tes (xws li tuav lub dart), siv lub zog axial los ntawm kev thawb rau saum tus kov nrog tus ntiv tes xoo. Tus kov yuav tsum muaj kev tiv thaiv -slip tsim thiab tsis txhob tsim cov torque ntxiv ntawm xibtes.

Valve/stopcock: A 90-degree hloov pauv yog nyob ntawm tus kov-sib npaug rau lub axis rau qhib, qhib rau kaw. Lub valve no ua haujlwm ob lub hom phiaj:

Txhawm rau tswj seb CO₂ ntws los ntawm lub lumen sab hauv ntawm rab koob mus rau hauv lub plab kab noj hniav

Kev siv tshuaj ntsuam xyuas- tom qab xuas nrig ntaus, lub valve tuaj yeem qhib; Yog tias rab koob yuam kev nkag mus rau hauv txoj hnyuv lumen lossis cov hlab ntsha, cov ntsiab lus (cov kua dej hauv plab / cov ntshav) tuaj yeem tawm ntawm qhov qhib lossis raug nqus los ntawm cov koob txhaj tshuaj kom paub meej.

Qhov taw qhia kev nyab xeeb xim cim / xim liab (ntawm qee tus qauv): Qhov taw qhia liab nyob ze ze ntawm qhov kawg ntawm Veress rab koob txav mus rau hauv tandem nrog lub hauv paus hloov chaw, pab tus neeg teb xov tooj txiav txim siab seb qhov blunt tip tau txuas ntxiv mus rau nws txoj haujlwm tiv thaiv "deployed"

Ib -Siv kab lus ntawm Cov Txheej Txheem Txheej Txheem

Cheebtsam|Muaj nuj nqi|Cov yam ntxwv tseem ceeb

Sab nrauv|Txiav Channel|Beveled ntug, 2 hli OD, polished hloov

Inner Core|Lub cev tiv thaiv|Nthuav taub, hollow nrog sab qhov, ntev tshaj li txheej sheath

Caij nplooj ntoos hlav|Tsis Siv Neeg Kev Nyab Xeeb|Calibrated rau 2–3 N, stroke ≈ 2 mm, xauv- tawm tshuab

Kov/Valve|Kev Ua Haujlwm + Cua|Luer kev twb kev txuas, stopcock plug, taw qhia cim

Lub ci ntsa iab ntawm Veress rab koob tag nrho cov qauv tsim nyob rau hauv nws lub caij nplooj ntoos hlav ua haujlwm nkaus xwb - lub tog raj kheej, uas tau ua tiav qhov kev nyab xeeb raws li - nkag → thim rov qab → daim thaiv kev xa tawm - yam tsis muaj kev cia siab rau lub tshuab hluav taws xob lossis lub koob yees duab. Qhov no yog qhov tseeb vim li cas, txawm tias tom qab ze li ib puas xyoo thiab txawm tias siv dav dav ntawm optical trocars, Veress koob tseem tuav ib qho chaw ruaj khov hauv ntau qhov chaw phais: nws cov qauv yooj yim ua kom paub tseeb txog kev ua tsis tiav, thiab kev kwv yees nws tus kheej yog kev nyab xeeb.