Laparoscopic entry techniques: What is the controversy?

Abstract

Objective: To review reported complications related to the different laparoscopic entry techniques in the human and veterinary literature and describe the benefits and limitations of each technique. Study design: Literature review of 57 peer-reviewed articles. Methods: An electronic database search identified human and veterinary literature describing complications related to entry technique during laparoscopy. Results: Open-and closed-entry techniques may result in trauma of abdominal organs or vasculature. During laparoscopy in man, injury to bowel and major vasculature is reported in 0.02% and 0.04% of procedures with open-or closed-entry techniques, respectively. Designs of Veress needles and trocar cannula assemblies have been developed to improve ease and safety. Early complications, defined as those observed at the time of port entry into the abdominal cavity, result from the puncture of a blood vessel leading to substantial visible hemorrhage. Late complications are detected 24 or 48 hours after surgery and result from the puncture of a loop of intestine that was not detected at the time of initial surgery. The major reasons for iatrogenic trauma in man are related to anatomical factors and the presence of adhesions. No explanation for cause of complications was identified for animals. Conclusion: There is no consensus in the human or veterinary literature about the best entry technique for laparoscopy. The rate of complications related to entry technique in small animals is not known because the data are underreported. Clinical significance: Complications related to entry techniques are expected in both man and animals. Improvements in techniques and equipment design are being developed to minimize risk.

A Comparison of Times Taken for the Placement of the First Portal and Complication Rates between the Veress Needle Technique and the Modified Hasson Technique in Canine Ovariectomy Laparoscopic Surgery

“…The Veress needle technique in human medicine has been associated with several major complications, such as bowel and vascular perforations [35]. In dogs and cats, both entry techniques have been used, and the risk of iatrogenic injury with either entry method has not been well determined [2].…”

“…Laparoscopy is a minimally invasive surgical technique for viewing the internal structures of the abdomen [1]. Laparoscopy was initially used almost only for diagnostic procedures in veterinary medicine [2]. In recent decades, laparoscopic ovariectomy and cryptorchidectomy procedures were performed and described in the veterinary literature [3][4][5].…”

“…Laparoscopic procedures have several advantages compared with open surgery: a larger field of surgery, reduced post-surgical pain and associated stress, a reduced infection rate, and less hospitalization time [10][11][12][13][14]. There is evidence in human medicine that laparoscopy is associated with a reduced overall risk of complications, compared with traditional laparotomy [2]. There are, however, risks associated with the insertion of instruments through small surgical accesses sites [15].…”

“…A fatal embolism has been reported [26]. In the veterinary literature, guidelines for establishing a safe and rapid pneumoperitoneum are lacking, and few surgical studies have been conducted [2].…”

A systematic review of complications related to laparoscopic and laparoscopic‐assisted procedures in dogs

“…Conversely, Pope and Knowles 11 identified no significant difference in the incidence of splenic laceration with Veress or open technique. The true rate of complications related to abdominal entry technique in small animal laparoscopic surgery is most likely underreported, 82 and there is a requirement for large prospective RCT to determine the superiority of one technique over another 81 …”