Laparoscopic entry techniques

Ahmad, Gaity; Gent, David; Henderson, Daniel R.; O’Flynn, Helena; Phillips, Kevin G.; Watson, Andrew

doi:10.1002/14651858.cd006583.pub4

Cited by 195 publications

(72 citation statements)

References 63 publications

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“…In a study by Ahmed et al no case of EPI with DT and 5.9% with VN out of which 3.4% cases of subcutaneous emphysema and 2.5% cases of preperitoneal insufflation. 7 Similar results were found by Roberto Angilio et al in 2013. 10 No events were recorded for mortality or gas embolism.…”

Section: Extra-peritoneal Insufflations (Epi)supporting

confidence: 83%

“…Due to imprecision and lack of reporting of study methods the evidence obtained was of poor quality. 7 The controversy regarding the best and safest method for the creation of pneumoperitoneum still persists, and every laparoscopic surgeon wants to know the safest entry technique to be followed. So, in this study risks and benefits of two different entry techniques commonly practiced by gynaecologists are analysed.…”

Section: Introductionmentioning

confidence: 99%

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Risks and benefits of two different entry techniques for laparoscopic gynecological surgeries

Agarwal

Yadav

Agarwal

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Primary abdominal access still remains a challenge for laparoscopic surgery despite rapid advances. This study was conducted to prospectively analyse and compare risks and benefits of two different entry techniques namely, veress needle and direct trocar in laparoscopic gynaecological surgeries so as to obtain consensus on the optimal method to be followed to create pneumoperitoneum.Methods: This was a prospective randomized study conducted at Deen Dayal Upadhyay hospital, under Delhi government. During the period January 2014 to June 2016, 800 patients (20-65 years) operated laparoscopically by the same team of surgeons for various gynaecological conditions, were randomized in two groups: Veress needle group (VN) and Direct trocar group (DT). Each group comprised of 400 patients. Comparison of various parameters was done between the two groups.Results: Incidence of major complications in terms of visceral injuries was 0.75% (3/400) in DT group and nil in VN group. Open conversion rate (2/400 i. e. 0.5%) and number of attempts required to create pneumoperitoneum were also more in DT group. Failed access in previous surgery cases was 1.2% (1/38) in VN and 14.8% (4/27) in DT group. Incidence of port site bleeding (n=3) was also more in DT group. Although the incidence of minor complications such as extraperitoneal insufflations (n=5) and no. of failed access (n=6) were more in VN group, there was no incidence of any life-threatening complication.Conclusions: In our experience, there is clear evidence of advantage of using veress needle in preventing major complications. Veress needle is therefore safer, convenient and effective technique of creating pneumoperitoneum.

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Section: Extra-peritoneal Insufflations (Epi)supporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Risks and benefits of two different entry techniques for laparoscopic gynecological surgeries

Agarwal

Yadav

Agarwal

2017

Int J Reprod Contracept Obstet Gynecol

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“…These complications are by far very rare. 1,2 The rapid advancement in science in CCD cameras and the flexible light sources have made the laparoscopic surgery more affordable and widely available. As a result, the use of laparoscopy has expanded to more sophisticated surgeries as well as management of malignancies.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic port site complications: a study in a tertiary care centre

Ravindranath

Reddy

2016

Int Surg J

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“…A meta-analysis published recently found no difference in major vascular or visceral complications. There was, however, a lower incidence of failed entry with the open technique, as well as less extraperitoneal insufflation and omental lesion [23].…”

Section: Discussionmentioning

confidence: 91%

Closed entry technique for the laparoscopic management of adnexal mass during pregnancy

et al. 2014

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Management of adnexal masses during pregnancy is challenging for most gynecologists. When surgery is needed, a minimally invasive approach should be preferred. The aim of this study was to evaluate the safety and feasibility of the closed entry technique for laparoscopic management of adnexal masses during pregnancy. We reviewed clinical records and videos of laparoscopic procedures performed during pregnancy. Seventeen pregnant patients with diagnosis of adnexal mass that required surgery underwent laparoscopic surgery using the closed entry or Veress technique. We searched for complications related to surgery and obstetrical and perinatal outcomes. Median gestational age at the moment of surgery was 17 weeks (range, 6-30 +4 weeks). A total of 18 interventions were performed: 12 salpingo-oophorectomies, 3 cystectomies, 1 salpingectomy, and 2 ovarian detorsions. There were no major operative or entry-related complications. Median hospital stay was 2 days (range, 1-5). Perinatal outcomes were as follows: four preterm births (all of them induced), nine full-term deliveries, one early pregnancy loss at 7 weeks, one miscarriage at 18 weeks, and two ongoing uncomplicated pregnancies. Laparoscopic approach using closed entry technique with an individual selection of the puncture site is safe in the management of adnexal masses that require surgery during pregnancy. In our experience, the Veress technique is more versatile as it gives the surgeon more freedom to choose the location of the first trocar in patients with important space limitations due to the size of the adnexal mass and/or the enlarged gravid uterus.

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Laparoscopic entry techniques

Cited by 195 publications

References 63 publications

Risks and benefits of two different entry techniques for laparoscopic gynecological surgeries

Risks and benefits of two different entry techniques for laparoscopic gynecological surgeries

Laparoscopic port site complications: a study in a tertiary care centre

Closed entry technique for the laparoscopic management of adnexal mass during pregnancy

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