Open Port Placement of the First Laparoscopic Port: A Safe Technique

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Abstract

Background:

Blind insertion of the Veress needle and of the first trocar is a significant cause of complications in laparoscopic surgery. Despite this risk, the closed technique is still more popular than the open one. Our aim is to report the results of our experience with the routine use of the modified open technique in laparoscopic surgery and to describe the technical details of the creation of pnuemoperitoneum by the open technique that we used.

Methods:

A prospective study was conducted in the department of surgery at Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi. A modified method of open laparoscopy was performed on 755 consecutive patients requiring laparoscopy or laparoscopic surgery over a 5-year period from August 1998 to February 2003 in 1 surgical unit.

Results:

The mean time taken was 4 minutes (range, 2 to 10). No intraoperative complications occurred during trocar insertion. Forty-nine (6.49%) patients had minor umbilical sepsis, 22 (2.91%) had periumbilical hematoma, but none had umbilical hernia during 3 months of follow-up after surgery.

Conclusion:

Based on our own experience, we recommend open laparoscopy as a safe and easy approach for routine laparoscopic interventions.

Related collections

Most cited references 19

Record: found
Abstract: found
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A nationwide analysis of laparoscopic complications.

P Härkki, T Kurki (1996)

To evaluate the nationwide incidence of laparoscopic complications, as the number of demanding gynecologic laparoscopic procedures increases worldwide. The National Patient Insurance Association was founded in 1987 in Finland. All major complications are reported to the Association because it handles financial compensation for patients' injuries without proof of malpractice. We analyzed 256 complications following laparoscopic procedures occurring in 1990-1994. There were 160 minor complications, which were defined as mild infections, mild hemorrhages, and failed sterilization. In all, 96 major complications occurred, including intestinal, urinary tract, and vascular injuries. The number of gynecologic laparoscopies (70,607 procedures) was obtained from the Finnish Hospital Discharge Register. The total complication rate was 3.6/1000 procedures, and the rate of major complications was 1.4/1000 procedures. In diagnostic laparoscopies, the annual major complication rate was constantly below 0.6/1000, and in sterilization, it was below 0.8/1000. In operative laparoscopies, major complications increased from 0/1000 in 1990 to 10.5/1000 in 1993 and leveled to 10.1/1000 in 1994. In all, intestinal injuries occurred in 0.6/1000, ureteral injuries in 0.3/1000, bladder injuries in 0.3/1000, and vascular injuries in 0.1/1000 laparoscopic procedures. Diagnostic and sterilization laparoscopies appear to be safe, but more complex laparoscopies are associated with an unacceptably high number of serious complications requiring continuous follow-up and expertise.

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Major vascular injuries during gynecologic laparoscopy.

Charles Chapron, Fabrice Pierre, Sylvie Lacroix … (1997)

This study was undertaken to report our experience with major vascular injuries in gynecologic laparoscopy in order to specify the circumstances under which they occurred, the means of diagnosis, the risk factors, and the means for prevention. Retrospective case review study. Seventeen patients with 21 major vascular injuries were identified. The average age of the patients was 33.8 +/- 11.6 years, and the mean body index mass was 21.6 +/- 3.08 kg/m2. Three of four of the accidents occurred during the set-up phase of laparoscopy (13 cases; 76.5%), and in 4 cases (23.5%) the accident occurred during the laparoscopic surgery procedure. Eleven (84.6%) of the complications occurring during the set-up phase were secondary to insertion of the umbilical trocar and 2 (15.4%) to insertion of the needle used to create the pneumoperitoneum (P-needle). Half (6 cases; 54.5%) of the major vascular injuries secondary to insertion of the umbilical trocar were observed when reusable trocars were used. In every case, the diagnosis was made during the operation. Two patients died, and two others presented a serious complication (phlebitis; acute ischemia requiring reoperation). Major vascular injuries are rare but serious complications of laparoscopic surgery. Prevention of these accidents relies on the surgeon's experience and scrupulous respect of the safety rules. In the vast majority of cases, it is necessary to convert to laparotomy immediately, calling in a vascular surgeon.

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Major vascular injury and laparoscopy.

Sean Cregan, Stephen R Hanney, K Alle (1995)

Iatrogenic vascular trauma is a hazard that must be considered constantly during any laparoscopic procedure. We present a case of vessel penetration presenting as CO2 embolism during insufflation where delayed recognition of the vascular implications of this event led to death from exsanguination. The pattern of laparoscopic vascular injuries in Australia as reported to the Medical Defence Union (UK) and the New South Wales Medical Defence Union is reviewed and compared with previously reported cases of vascular trauma in laparoscopy. Recommendations are made for the diagnosis and most importantly for the prevention of CO2 embolism and major vascular injury at laparoscopy.

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Author and article information

Journal

Journal ID (nlm-ta): JSLS

Journal ID (iso-abbrev): JSLS

Journal ID (hwp): jsls

Journal ID (pmc): jsls

Journal ID (publisher-id): JSLS

Title: JSLS : Journal of the Society of Laparoendoscopic Surgeons

Publisher: Society of Laparoendoscopic Surgeons (Miami, FL )

ISSN (Print): 1086-8089

ISSN (Electronic): 1938-3797

Publication date (Print): Oct-Dec 2004

Volume: 8

Issue: 4

Pages: 364-366

Affiliations

Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi –110 002, India.

Author notes

Address reprint requests to: Pawan Lal, MBBS, MS, DNB, MNAMS, C–63, Preet Vihar, Delhi - 110092, India. Telephone: 91 11 22549343, 91 11 22549342, E-mail: pawanlal@ 123456vsnl.com and lalpawan@ 123456hotmail.com

Article

PMC ID: 3016831

PubMed ID: 15554282

SO-VID: e38e60e6-415a-4efa-a68d-b86cdc584311

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License ( http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.

Open Port Placement of the First Laparoscopic Port: A Safe Technique

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Abstract

Background:

Methods:

Results:

Conclusion:

Related collections

SICOT-J (Orthopedic surgery and traumatology)

Most cited references 19

A nationwide analysis of laparoscopic complications.

Major vascular injuries during gynecologic laparoscopy.

Major vascular injury and laparoscopy.

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