Trocar injuries in laparoscopic surgery

Primary access-related complications with laparoscopy: Comparison of blind and open techniques

“…These frequencies compares with the lower range in other studies reporting 0.04% to 4% for the technique Veress and 0% to 1.3% for the open technique [5,13]. Mortality from visceral injuries is reported to vary between 1.6% and 10% [4][5][6]. The mortality rate is high for patients with injuries overlooked intraoperatively.…”

“…The MVI rate was found to be 0.075% in a review of 490,000 operations using blind access and 0% in a review of 12,000 operations using open access [5]. Although these complications are rare, the mortality rate is high and variable (0.8-17%) [4][5][6]. Hanney et al [9] reported two cases of aortic injury with the Hasson cannula: one caused by the skin incisions that immediately injured the aorta and the second caused by a metal burr at the tip of an aging, reusable Hasson cannula.…”

“…Mortality was seen in 6.4% of the vascular and 3.3% of the visceral injuries. No report was registered on the open Hasson trocar [4].…”

“…Using the blind technique, visceral injury is more likely to be overlooked and detected first postoperatively. This may result in a higher morbidity and mortality, as compared with an intraoperatively recognized injury using the open technique [4]. Detecting a clinically significant difference of 0.19% to 0.23% with a power of 90% between blind and open access regarding MVIs requires approximately 10,000 patients in each group because of the low frequency of the complications [13].…”

Three simple steps during closed laparoscopic entry may minimize major injuries

“…Pneumoperitoneum has been described as ''adequate'', ''appropriate'' or ''sufficient,'' established by an arbitrary volume of 1-4 L of CO 2 without regard to intra-abdominal pressure. Final pressures of 10 mmHg [33], 15 mmHg [20,29,34], 14-18 mmHg [35], 20 mmHg [26,36], 25 mmHg [21,27,[36][37][38][39], and 30 mmHg [22,40] have been advocated [8]. To determine the most appropriate pressure Phillips et al measured the vertical depth of pneumoperitoneum at the umbilicus in 43 women undergoing laparoscopy when volume and pressure of insufflated CO 2 varied [37,41].…”