Laparoscopic entry technique—a survey of practices of consultant gynaecologists

Abstract

To assess the mode of laparoscopic entry technique among consultant gynaecologists in the United Kingdom and Ireland and to find out whether recent recommendations have influenced practice, an anonymous postal questionnaire was sent to 1,190 gynaecologists. Responses were analysed using an Excel spreadsheet. There was a 64% response rate. Of the respondents, the majority (90%) performed laparoscopy by using a Veress needle technique. Regarding the patient's position when inserting the scope, 61% used lithotomy with Trendelenberg tilt, and 39% used the flat position. The entry point used was subumbilical by 54% and intraumbilical by 44%. Thirty-eight percent used pressure and 62% used volume to decide when to insert the primary trocar. Only 26% of responding gynaecologists were aware of the Middlesbrough consensus document, but most who had attended a course were compliant with the guidelines. In conclusion, the majority of gynaecologists practiced closed laparoscopy and used the volume technique to achieve pneumoperitoneum. Only a small number of gynaecologists were aware of the recent recommendations regarding safe laparoscopic entry technique, suggesting that methods for disseminating recommendations must be improved.

Laparoscopic entry techniques and complications

“…The consensus document [3] was devised to guide gynecologists to ensure safe entry at laparoscopy. This survey provides similar results to a previous survey that showed a significant deviation from the guidance among practicing gynecologists in the United Kingdom [9].…”

Guideline on preventing entry-related gynaecological laparoscopic injuries: post-publication reflections of the senior author

“…Only 16% insufflated to 25 mmHg, and fully, a third (32%) admitted to insufflating to only 15 mmHg or less. Sadly, only 39% had the patient in the supine position before inserting the Veress needle, only 44% inserted the needle beneath the umbilicus, 43% used a transverse incision and incredibly 56% did not check that the needle was correctly positioned [43].…”

A new technique in laparoscopic abdominal access (Evsen Method, Modified Veress Technique)

“…In endoscopic surgery, gynecologic surgeons often prefer the method of establishing the pneumoperitoneum with the Veress needle [10,11]. In the Veress method, there is a certain degree of risk of failure in establishing the pneumoperitoneum, as well as the risk of subcutaneous air leakage.…”

“…The open (Hasson) method is not preferred since the time to enter the peritoneal cavity and the learning curve are longer, the rate of gas leakage is higher, and surgeons performing gynecological endoscopy have limited experience with the method [5,10,11]. With direct trocar insertion, the pneumoperitoneum can be established faster as compared to the open and classical Veress method.…”