Palmers点禁忌症中的Jain点腹腔镜入路

进行这项研究是为了评估Jain点克服Palmer点禁忌症的功效。 Jain点位于左腹 L4 水平，脐外侧 10-13cm 处。 由于其解剖学位置，Jain 点没有粘连，因为术后粘连通常发生在中线或右侧。

这是一项在高容量三级医疗转诊中心进行的高级妇科腹腔镜手术的回顾性研究，纳入了 2011 年 1 月至 2022 年 3 月在该中心接受腹腔镜手术的 8,586 名患者。在本文中，分析了 2,519 名既往有既往手术史的患者 使用Jain点进行手术的手术。

在有既往手术史的 2,519 名患者中，无论疤痕位置、既往手术的次数和类型，以及Palmer点禁忌症患者，均发现耆那氏点端口无粘连。 除了一例 (0.04%) 的小肠损伤外，没有报告重大并发症，该病例在术中进行了处理。 Jain 点继续作为主要的符合人体工程学的工作端口发挥作用。

Jain点为普通外科医生、泌尿科医生、肿瘤科医生和减肥外科医生等不同专业的腹腔镜外科医生在以往的手术案例中提供了一个替代的安全入口，以克服Palmer点的禁忌症。 Jain 点也是人体工程学的主要工作端口，而 Palmer 点在初次进入后就变得多余了。

Palmers点禁忌症中的Jain点腹腔镜入路

(A) Jain 点的表面标记，显示距脐和左下端口的距离。 患者在手术后出现败血症，随后进行了多次结肠造口术和结肠造口闭合手术。 (B) 手指从腹壁按压 Palmer 点，显示肠环卡在上腹部。 Jain 点可避免 IIA 型肠粘连。

Palmers点禁忌症中的Jain点腹腔镜入路

(A) Jain 点的概念； 它模仿坐在手术场外的网球场上裁判的位置。 (B) Jain 点同样适用于上腹部、中腹部和下腹部疤痕。

Palmers点禁忌症中的Jain点腹腔镜入路

Jain点在L4水平，脐旁10-13cm，远离左侧脏器（脾、肾、胃胀）和乙状结肠，左侧宽新生区从L1到 盆腔，没有血管、内脏、粘连和肠管。

Palmers点禁忌症中的Jain点腹腔镜入路

(A) 在 Jain 点端口的直视下插入 10mm 端口，成为主要工作端口。 (B) 同侧端口使肌瘤切除术和缝合符合人体工程学。

1. Schreinemacher MH, ten Broek RP, Bakkum EA, van Goor H, Bouvy ND. Adhesion awareness: a national survey of surgeons. World J Surg. (2010) 34(12):2805–12. 10.1007/s00268-010-0778-8   
2. Szomstein S, Lo Menzo E, Simpfendorfer C, Zundel N, Rosenthal RJ. Laparoscopic lysis of adhesions. World J Surg. (2006) 30(4):535–40. 10.1007/s00268-005-7778-0   
3. Tinelli A, Malvasi A, Schneider AJ, Keckstein J, Hudelist G, Barbic M, et al. Primo accesso addominale in laparoscopia ginecologica: quale tecnica utilizzare? [First abdominal access in gynecological laparoscopy: which method to utilize?]. Minerva Ginecol. (2006) 58(5):429–40. Italian  
4. Taskforce for Abdominal Entry. Principles of safe laparoscopic entry. Eur J Obstet Gynecol Reprod Biol. (2016) 201:179–88. 10.1016/j.ejogrb.2016.03.040   
5. Palmer R. Safety in laparoscopy. J Reprod Med. (1974) 13(1):1–5  
6. Jain N, Sareen S, Kanawa S, Jain V, Gupta S, Mann S. Jain point: a new safe portal for laparoscopic entry in previous surgery cases. J Hum Reprod Sci. (2016) 9(1):9–17. 10.4103/0974-1208.178637   
7. Sharp HT. Overview of gynecologic laparoscopic surgery and non-umbilical entry sites. In: Falcone T, editors. Wolters Kluwers (2019). p. 10. UpToDate.
8. Jain N, Jain V, Chandi A, Srivastava S, Singh S, Vasundhara N. Jain point: an alternate laparoscopic non-umbilical first blind entry port to avoid vessel, viscera, adhesions and bowel (VVAB). Updates Surg. (2021) 73(6):2321–9. 10.1007/s13304-021-01099-z   
9. Reich H. Foreword. In: Jain N, editors. Non-umbilical laparoscopic entry ports, 1st ed. New Delhi: Jaypee Brothers Medical Publishers; (2020).
10. Mohapatra GSS, Bhusan B. Comparative study of different entry sites in laparoscopic surgery: which is safest? IOSR J. Dent. Med. Sci. (IOSR-JDMS). (2017) 16(1):64–6. 10.9790/0853-1601086466  
11. Diamond MP. Reduction of de novo postsurgical adhesions by intraoperative precoating with sepracoat (HAL-C) solution: a prospective, randomized, blinded, placebo-controlled multicenter study. The Sepracoat Adhesion Study Group. Fertil Steril. (1998) 69(6):1067–74. 10.1016/s0015-0282(98)00057-0   
12. Jain N, Sareen S, Kanawa S, Jain V, Gupta S, Mann S. Jain point: A new safe portal for laparoscopic entry in previous surgery cases. J. Hum. Reprod. Sci. (2016) 9(1):9–17. 10.4103/0974-1208.178637   
13. Giannios NM, Gulani V, Rohlck K, Flyckt RL, Weil SJ, Hurd WW. Left upper quadrant laparoscopic placement: effects of insertion angle and body mass index on distance to posterior peritoneum by magnetic resonance imaging. Am J Obstet Gynecol. (2009) 201(5):522.e1-5. 10.1016/j.ajog.2009.07.017   
14. Debi U, Ravisankar V, Prasad KK, Sinha SK, Sharma AK. Abdominal tuberculosis of the gastrointestinal tract: revisited. World J Gastroenterol. (2014) 20(40):14831–40. 10.3748/wjg.v20.i40.14831   
15. Gupta N, Sharma JB, Mittal S, Singh N, Misra R, Kukreja M. Genital tuberculosis in Indian infertility patients. Int J Gynaecol Obstet. (2007) 97(2):135–8. 10.1016/j.ijgo.2006.12.018   
16. Sharma JB, Roy KK, Pushparaj M, Gupta N, Jain SK, Malhotra N, et al. Genital tuberculosis: an important cause of Asherman's syndrome in India. Arch Gynecol Obstet. (2008) 277(1):37–41. 10.1007/s00404-007-0419-0   
17. “India records 2.15 m new TB patients in 2018”. The Nation. 2019-03-26. Retrieved 2019-03-27.
18. Jain N, Kanwar M. Laparoscopy in genital Tuberculosis. In: Jain N, editors. State of the art atlas of endoscopic surgery in infertility and gynaecology. New Delhi, India: Jaypee Brothers; (2004). p. 425–39.
19. Jain N. A rare case of encapsulated caseous ball. J Minim Invasive Gynecol. (2007) 14:557–8. 10.1016/j.jmig.2007.03.006   
20. Sharma JB, Roy KK, Gupta N, Jain SK, Malhotra N, Mittal S. High prevalence of Fitz-Hugh-Curtis syndrome in genital tuberculosis. Int J Gynaecol Obstet. (2007) 99(1):62–3. 10.1016/j.ijgo.2007.03.024   
21. Sharma JB, Roy KK, Pushparaj M, Kumar S, Malhotra N, Mittal S. Laparoscopic findings in female genital tuberculosis. Arch Gynecol Obstet. (2008) 278(4):359–64. 10.1007/s00404-008-0586-7   
22. Lee CL, Huang KG, Jain S, Wang CJ, Yen CF, Soong YK. A new portal for gynecologic laparoscopy. J Am Assoc Gynecol Laparosc. (2001) 8(1):147–50. 10.1016/s1074-3804(05)60565-8   
23. Lam KW, Pun TC. Left upper quadrant approach in gynecologic laparoscopic surgery using reusable instruments. J Am Assoc Gynecol Laparosc. (2002) 9(2):199–203. 10.1016/s1074-3804(05)60132-6   
24. Agarwala N, Liu CY. Safe entry techniques during laparoscopy: left upper quadrant entry using the ninth intercostal space–a review of 918 procedures. J Minim Invasive Gynecol. (2005) 12(1):55–61. 10.1016/j.jmig.2004.12.026   
25. Tulikangas PK, Nicklas A, Falcone T, Price LL. Anatomy of the left upper quadrant for cannula insertion. J Am Assoc Gynecol Laparosc. (2000) 7(2):211–4. 10.1016/s1074-3804(00)80042-0   
26. Hasson HM. Open laparoscopy as a method of access in laparoscopic surgery. Gynaecol Endosc. (1999) 8:353–62. 10.1046/j.1365-2508.1999.00316.x  
27. Vilos GA, Ternamian A, Dempster J, Laberge PY, Vilos G, Lefebvre G, et al. Laparoscopic entry: a review of techniques, technologies, and complications. J Obstet Gynaecol Can. (2007) 29(5):433–47. 10.1016/S1701-2163(16)35496-2   
28. Dunne N, Booth MI, Dehn TC. Establishing pneumoperitoneum: Verres or Hasson? The debate continues. Ann R Coll Surg Engl. (2011) 93(1):22–4. 10.1308/003588411X12851639107557   
29. Jain N, Jain V, Agarwal C, Bansal P, Gupta S, Bansal B. Left lateral port: safe laparoscopic port entry in previous large upper abdomen laparotomy scar. J Minim Invasive Gynecol. (2019) 26(5):973–6. 10.1016/j.jmig.2018.10.017   
30. Jain N, Jain V, Gupta S. Jain point: to study the efficacy and safety in previous upper abdominal scars. J Minim Invasive Gynecol. (2021) 28(11):Supplement, S115. 10.1016/j.jmig.2021.09.179  
31. Sharma JB, Mohanraj P, Roy KK, Jain SK. Increased complication rates associated with laparoscopic surgery among patients with genital tuberculosis. Int J Gynecol Obstet. (2010) 109:242–4. 10.1016/j.ijgo.2010.01.011   
32. Gupta S, Gupta P, Jain N. Jain point in the practice of general surgery. In: Jain N. Non-umbilical laparoscopic entry ports, 1st ed. New Delhi: Jaypee brothers medical publishers; (2020) p. 254–73.
33. Marco A, In Sociedad Espanola (SEGO). https://sego.es/views/pildorasin ... NTES_JAIN_POINT.mp4
34. Carrubba AR, McKee DC, Wasson MN. Route of hysterectomy: straight stick laparoscopy. J Gynecol Surg. (2021) 37(2):107–11. 10.1089/gyn.2020.0223  
35. Bedaiwy MA, Yong PJ, Farghaly TA, Abdelhafez FF, Tan J, Pope R, et al. The effect of age and body mass index on the surgical anatomy of supraumbilical port insertion: implications for laparoscopic and robotic surgery. Gynecol Obstet Invest. (2018) 83(6):546–51. 10.1159/000488676   
36. Clark NV, Einarsson JI. 5. Laparoscopic entry techniques. In: Saridoğan E, Kilic GS, Ertan K, editors. Minimally invasive surgery in gynecological practice: Practical examples in gynecology. Berlin, Boston: De Gruyter; (2020). p. 50–60. 10.1515/9783110535204-005  
37. Reynolds R. Development of an intraperitoneal catheter placement device for use on the battlefield M.S. Thesis. University of Nebraska-Lincoln; (2021).
38. Eamudomkarn N, Luanratanakorn S, Seejorn K. Alternative access sites for abdominal entry in gynecologic laparoscopy: a literature review and narrative summary of findings. Srinagarind Med J. (2021) 36(2):240–5. Available from: https://li01.tci-thaijo.org/index.php/SRIMEDJ/article/view/249590
39. Salcedo AMC, Guarin CB, Jaramillo JDL, Isanoa JDL, Gutierrez DLP, Echeverri JDV. Glob. libr. women's med., ISSN: 1756-2228. 10.3843/GLOWM.415713
40. Recknagel JD, Goodman LR. Clinical perspective concerning abdominal entry techniques. J Minim Invasive Gynecol. (2021) 28(3):467–74. 10.1016/j.jmig.2020.07.010   
41. Pepin K. Abdominal entry in laparoscopic surgery. Contemp OB/GYN J. (2020) 65(11):20–3.
42. Jirecek S, Dräger M, Leitich H, Nagele F, Wenzl R. Direct visual or blind insertion of the primary trocar. Surg Endosc. (2002) 16(4):626–9. 10.1007/s00464-001-9089-3   
43. Ternamian AM. A trocarless, reusable, visual-access cannula for safer laparoscopy; an update. J Am Assoc Gynecol Laparosc. (1998) 5(2):197–201. 10.1016/s1074-3804(98)80091-1   
44. Mulayim B, Aksoy O. Direct trocar entry from left lateral port (Jain point) in a case with previous surgeries. J Gynecol Surg. (2020) 36(1). 10.1089/gyn.2019.0077