Entry complications in laparoscopic surgery

S Krishnakumar, P Tambe, S Krishnakumar, P Tambe

Abstract

To review the complications associated with laparoscopic surgery and provide clinical direction regarding the best practice based on the best available evidence. The laparoscopic entry techniques and technologies reviewed include the classic pneumoperitoneum (Veress/trocar), the open (Hasson), the direct trocar insertion, the use of disposable shielded trocars, radially expanding trocars and visual entry systems. Medline, Pubmed and Cochrane Databases were searched for English language articles published before December 2008. It is an evidence based fact that minimal access surgery is superior to conventional open surgery since this is beneficial to the women, community and the healthcare system.Over the past 50 years, many techniques, technologies and guidelines have been introduced to eliminate the risks associated with laparoscopic entry. No single technique or instrument has been proved to eliminate laparoscopic entry associated injury. Proper evaluation of the women, supported by surgical skills and good knowledge of the technology and instrumentation is the keystone to safe access and prevention of complications during laparoscopic surgery.

Keywords: Direct trocar; entry; laparoscopy; laparoscopy complications; open access (Hasson) technique; pneumoperitoneum; shielded trocar; veress needle; visual entry system.

Conflict of interest statement

Conflict of Interest: None.

Figures

Figure 1
Figure 1
Structures encountered during entry through the umbilicus
Figure 2
Figure 2
Veress entry technique and intra-abdominal pressure
Figure 3
Figure 3
Angulation of Veress’ needle in obese patients
Figure 4
Figure 4
Hasson's technique

References

    1. Chapron C, Fauconnier A, Goffinet F, Bréart G, Dubuisson JB. Laparoscopic surgery is not inherently dangerous for patients presenting with benign gynecologic pathology: results of a meta-analysis. Hum Reprod. 2002;17:1334–42.
    1. Jansen FW, Kapiteyn K, Trimbos-Kemper T, Hermans J, Trimbos JB. Complications of laparoscopy: a prospective multicentre observational study. Br J Obstet Gynaecol. 1997;104:595–600.
    1. Jansen FW, Kolkman W, Bakkum EA, de Kroon CD, Trimbos-Kemper TC, Trimbos JB. Complications of laparoscopy:an inquiry about closed versus open-entry technique. Am J Obstet Gynecol. 2004;190:634–8.
    1. Fuller J, Scott W, Ashar B, Corrado J. Laparoscopic trocar injuries: a report from a US FDA Center for Devices and Radiological Health (CDRH) Systematic Technology Assessment of Medical Products (STAMP) Committee. 2005 Aug 25;:1–14.
    1. Palmer R. Safety in laparoscopy. J Reprod Med. 1974;13:1–5.
    1. Hasson HM. A modified instrument and method for laparoscopy. Am J Obstet Gynecol. 1971;110:886–7.
    1. Dingfelder JR. Direct laparoscope trocar insertion without prior pneumoperitoneum. J Reprod Med. 1978;21:45–7.
    1. Byron JW, Fujiyoshi CA, Miyazawa K. Evaluation of the direct trocar insertion technique at laparoscopy. Obstet Gynecol. 1989;74:423–5.
    1. Lanvin D, Elhage A, Querleu D. Does the use of pneumoperitoneum and disposable trocars prevent bowel injury at laparoscopy.A randomised experimental study in the rabbit? Gynaecol Endosc. 1996;5:343–8.
    1. Riek S, Bachmann KH, Gaiselmann T, Hoernstein F, Marzusch K. A new insufflation needle with a special optical system for use in laparoscopic procedures. Obstet Gynecol. 1994;84:476–8.
    1. McGurgan P, O’Donovan P. Optical Veress as an entry technique. Gynaecol Endosc. 1999;8:379–92.
    1. Kaali SG. Introduction of the Opti-Trocar. J Am Assoc Gynecol Laparosc. 1993;1:50–3.
    1. Mettler I, Schmidt EH, Frank V, Semm K. Optical trocar systems: laparoscopic entry and its complications ( a study of case in Germany) Gynaecol Endosc. 1999;8:383–9.
    1. Turner DJ. A new radially expanding access system for laparoscopic procedures versus conventional cannulas. J Am Assoc Gynecol Laparosc. 1996;34:609–15.
    1. Turner DJ. Making the case for the radially expanding access system. Gynaecol Endosc. 1999:8391–5.
    1. Ternamian AM. Laparoscopy without trocars. Surg Endosc. 1997;11:8159–68.
    1. Ternamian AM. A second generation laparoscopic port system: EndoTIP. Gynaecol Endosc. 1999;8:397–401.
    1. Chandler JG, Corson SL, Way LW. Three spectra of laparoscopic entry access injuries. J Am Coll Surg. 2001;192:478–91.
    1. Ostrzenski A, Ostrzenska KM. Bladder injury during laparoscopic surgery. Obstet Gynecol. 1986;53:175–80.
    1. Härkki-Siren P, Sjöberg J, Kurki T. Major complications of laparoscopy: A follow-up Finnish study. Obstet Gynecol. 1999;94:94–8.
    1. Neudecker J, Sauerland S, Neugebauer E, Bergamaschi R, Bonjer HJ, Cuschieri A, et al. The European Association for Surgery Clinical Practice Guideline on the pneumoperitoneum for laparoscopic surgery. Surg Endosc. 2002;16:1121–43.
    1. Teoh B, Sen R, Abbott J. An evaluation of four tests used to ascertain Veres needle placement at closed laparoscopy. J Minim Invasive Gynecol. 2005;12:153–8.
    1. Brosens I, Gordon A. Bowel injuries during gynaecological laparoscopy: a multinational survey. Gynaecol Endosc. 2001;10:141–5.
    1. Vilos GA, Vilos AG. Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure. J Am Assoc Gynecol Laparosc. 2003;10:415–20.
    1. Vilos AG, Vilos GA, Abu-Rafea B, Hollett-Caines J, Al-Omran M. Effect of body habitus and parity on the initial Veress intraperitoneal (VIP) CO2 insufflation pressure during laparoscopic access in women. J Minim Invasive Gynecol. 2006;13:108–13.
    1. Hurd WW, Bude RO, DeLancey JO, Pearl ML. The relationship of the umbilicus to the aortic bifurcation: complications for laparoscopic technique. Obstet Gynecol. 1992;80:48–51.
    1. Richardson RF, Sutton CJG. Complications of first entry: a prospective laparoscopic audit. Gynaecol Endosc. 1999;8:327–34.
    1. Phillips G, Garry R, Kumar C, Reich H. How much gas is required for initial insufflation at laparoscopy? Gynaecol Endosc. 1999;8:369–74.
    1. Palmer R. Safety in laparoscopy. J Reprod Med. 1974;13:1–5.
    1. Sanders RR, Filshie GM. Transfundal induction of pneumoperitoneum prior to laparoscopy. J Obstet Gynaecol Br Commonw. 1994;107:316–7.
    1. Wolfe WM, Pasic R. Transuterine insertion of Veress needle in laparoscopy. Obstet Gynecol. 1990;75:456–7.
    1. van Lith DA, van Schie KJ, Beekhuizen W, du Plessis M. Cul-de-sac insufflation:an easy alternative route for safely inducing pneumoperitoneum. Int J Gynaecol Obstet. 1980;17:357–8.
    1. Lam KW, Pun TC. Left upper quadrant approach in gynecologic laparoscopic surgery with reusable instruments. J Am Assoc Gynecol Laparosc. 2002;9:199–203.
    1. Hasson HM. Open laparoscopy as a method of access in laparoscopic surgery. Gynaecol Endosc. 1999;8:353–62.
    1. Molloy D, Kaloo PD, Cooper M, Nguyen TV. Laparoscopic entry: A literature review and analysis of techniques and complications of primary port entry. Aust N Z J Obstet Gynaecol. 2002;42:246–54.
    1. Trocars: safety and selection. Emergency Care Research Institute. Health Devices. 1998;27:376–98.

Source: PubMed

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