Laparoscopic entry: a literature review and analysis of techniques and complications of primary port entry

Australian and New Zealand Journal of Obstetrics and Gynaecology - Tập 42 Số 3 - Trang 246-254 - 2002
David Molloy1, Philip Kaloo2, Michael Cooper1, Tuan V. Nguyen2
1Australian Gynaecological Endoscopy Society, University of New South Wales, Sydney, Australia
2Faculty of Medicine, University of New South Wales, Sydney, Australia

Tóm tắt

ABSTRACTObjectiveTo obtain consensus as to the optimal form of entry technique for access to the peritoneal cavity.DesignA meta‐analysis of all relevant English language studies of laparoscopic entry complications.Main outcome measuresIncidence of bowel and major vascular injuries.ResultsBowel injuries occur in 0.7/1000 and major vascular injuries in 0.4/1000. The overall incidence of major injuries at time of entry is 1.1/1000. The direct entry technique is associated with a significantly reduced major injury incidence of 0.5/1000, when compared to both open and Veress entry produces (1.1 and 0.9/1000 respectively, p = 0.0005). Entry‐related bowel injuries are reported more often following general surgical laparoscopies than with gynaecological procedures (p = 0.001). No such difference is seen in the incidence of vascular injuries (p = 0.987). Open entry is statistically more likely to be associated with bowel injury than either Veress needle or direct entry. However, open entry appears to minimize vascular injury at time of entry.ConclusionsThere remains no clear evidence as to the optimal form of laparoscopic entry in the low‐risk patient. However, direct entry may be an under‐utilised and safe alternative to the Veress needle and open entry technique.

Từ khóa


Tài liệu tham khảo

10.1097/00000658-199608000-00006

10.1111/j.1447-0756.1985.tb00052.x

10.1016/0002-9378(71)90593-X

10.1016/S0002-9610(99)00020-3

Ballem RV, 1993, Techniques of pneumoperitoneum, Surg Laparosc Endos., 3, 42

Sigman HH, 1993, Risks of blind versus open approach to celiotomy for laparoscopic surgery, Surg Laparosc Endos., 3, 296

Dingfelder JR., 1978, Direct laparoscope trocar insertion without prior pneumoperitoneum, J Reprod Me., 21, 45

Borgatta L, 1990, Direct trocar insertion vs Verres needle use for laparoscopic sterilization, J Reprod Me., 35, 891

Byron JW, 1993, A randomized comparison of Verres needle and direct trocar insertion for laparoscopy, Surg Gynecol Obste., 177, 259

10.1016/0029-7844(96)00215-3

Copeland C, 1983, Direct trocar insertion at laparoscopy: an evaluation, Obstet Gynecol., 62, 655

JansenFW KapiteynK Trimbos‐KemperT HermansJ TrimbosJB.Complications of laparoscopy: a prospective multicentre observational study Br J Obstet Gynaecol1997;104:595–600.

10.1111/j.1445-2197.1996.tb00798.x

10.1097/00006254-199803000-00022

10.1111/j.1471-0528.1999.tb08134.x

10.1046/j.1365-2508.1999.00316.x

10.1046/j.1365-2508.1999.00310.x

10.1046/j.1365-2508.1999.00300.x

10.3109/00016348709092947

Lehman‐Willenbrock E, 1949, Pelviscopy/laparoscopy and its complications in Germany, J Reprod Med, 37, 671

10.1046/j.1365-2168.1997.d01-1355.x

10.1006/gyno.1997.4738

Penfield AJ., 1985, How to prevent complications of open laparoscopy, J Reprod Med, 30, 660

10.1016/S0002-9610(05)80949-3

10.1097/00019509-199810000-00006

10.1007/s004649900898

10.1006/gyno.1996.0073

10.1016/S0029-7844(98)00566-3

10.1016/S0015-0282(16)58383-6

Mintz M., 1977, Risks and prophylaxis in laparoscopy: a survey of 100,000 cases, J Reprod Med, 18, 269

10.1136/bmj.2.6136.563-a

10.1111/j.1445-2197.1995.tb01800.x

10.1007/PL00009630

Baird DR, 1992, An early review of 800 laparoscopic cholecystectomies at a university‐affiliated community teaching hospital, Am Surg, 58, 206

Zaraca F, 1999, Routine use of open laparoscopy: 1,006 consecutive cases, J Laparosc Endosc, 9, 75

Hasson HM., 1978, Open laparoscopy vs closed: a comparison of complications rates, Adv Plann Parent, 13, 41

10.1016/S0015-0282(99)00555-5

10.1007/PL00012281

Palmer R., 1974, Safety in laparoscopy, J Reprod Me., 13, 1

10.1016/S1074-3804(05)80119-7

10.1016/S1074-3804(05)80095-7

10.1111/j.1479-828X.1999.tb03452.x

10.1016/S1074-3804(99)80069-3

10.1016/S1074-3804(99)80048-6

10.1016/S1074-3804(00)80042-0

10.1111/j.1479-828X.1997.tb02257.x

Kaali SG, 1992, Incidence of bowel injury due to dense adhesions at the sight of Direct trocar insertion, J Reprod Med, 37, 617

10.1016/S0002-9610(99)80214-1

10.1016/S0029-7844(96)00390-0

Phillips JM, 1982, American Association of Gynecologic Laparoscopists, J Reprod Med 1984, 29, 592

Schauer PR, 1999, Minilaparoscopy, Semin Laparosc Sur., 6, 21

10.1093/HUMREP/10.6.1461

Riek S, 1994, A new insufflation needle with a special optical system for use in laparoscopic procedures, Obstet Gynecol, 84, 476

Schaller G, 1995, The optical ‘Veress‐needle’ ‐ initial puncture with a minioptic, Endosc Surg All Technol, 3, 55

10.1016/S1074-3804(05)80758-3

10.1007/s004649900972

Mettler L, 1997, Clinical experience with an optical access trocar in gynecological laparoscopy‐pelviscopy, JSLS, 1, 315

10.1016/S1074-3804(05)80175-6

10.1016/S1074-3804(99)80046-2

10.1007/s004649900155

10.1381/096089299765553746

10.1016/S1074-3804(98)80091-1

10.1007/s004649900461

10.1111/j.1471-0528.1972.tb11880.x

Nezhat FR, 1991, Comparison of direct insertion of disposable and standard reusable laparoscopic trocars and previous pneumoperitoneum with Veress needle, Obstet Gynecol, 78, 148

10.1007/s001040050294

10.1007/s004649901095

10.1016/S0025-6196(12)65765-6

Perone N., 1992, Laparoscopy using a simplified open technique. A review of 585 cases, J Reprod Med, 37, 921

Nuzzo G, 1997, Routine use of open technique in laparoscopic operations, J Am Coll Surg, 184, 58

10.1089/lap.1997.7.285

Hasson HM., 1974, Open laparoscopy; a report of 150 cases, J Reprod Med, 12, 234

Saidi MH., 1986, Direct laparoscopy without prior pneumoperitoneum, J Reprod Med, 31, 684

Byron JW, 1989, Evaluation of the direct trocar insertion technique at laparoscopy, Obstet Gynecol, 74, 423

Jarrett JC, 1990, Laparoscopy: direct trocar insertion without pneumoperitoneum, Obstet Gynecol, 75, 725

10.1016/S1074-3804(96)80114-9

10.1016/0002-9610(92)90105-Z

10.1056/NEJM199305063281817

10.1016/S0002-9610(05)80397-6

Thông tin
Thông tin xuất bản

Australian and New Zealand Journal of Obstetrics and Gynaecology

Tập 42 Số 3

246-254

Thông tin tác giả