Guideline on preventing entry-related gynaecological laparoscopic injuries: post-publication reflections of the senior author

Sutton, Christopher

doi:10.1007/s10397-009-0498-y

Cited by 3 publications

References 32 publications

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A multidisciplinary evidence-based guideline for minimally invasive surgery: part 2—laparoscopic port instruments, trocar site closure, and electrosurgical techniques

et al. 2012

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Minimally invasive surgery (MIS) is practiced by different surgical disciplines applying similar basic techniques. In 2007, the Dutch Health Care inspectorate indicated the need for a guideline including multidisciplinary agreements for MIS aiming towards better patient care and safety. A multidisciplinary guideline development group was founded consisting of general surgeons, gynecologists, an anesthesiologist, and an urologist. All members were authorized by their scientific professional associations. Clinically important aspects were identified and discussed. The best available evidence on these aspects was gathered by systematic review. Recommendations for clinical practice were formulated based on the evidence and a consensus of expert opinion. The guideline was externally reviewed by members of the participating scientific associations and their feedback was integrated. Identified important topics were: laparoscopic entry techniques, intra-abdominal pressure, laparoscopic port instruments, electrosurgical techniques, prevention of trocar site herniation, patient positioning, anesthesiology, perioperative care, patient information, multidisciplinary user consultation, and complication registration. The text of each topic contains an introduction with an explanation of the problem and a summary of the current literature. The current available evidence on safety aspects in minimally invasive surgery is limited. Few conclusions could be deduced from evidence-based data. This underscores the need for larger studies with adequate design and methodology to define conclusions of importance. Above all, the development of this multidisciplinary guideline facilitated a rich discussion, which resulted in a very complete and implementable guideline. This is the second of three papers on the multidisciplinary guideline for minimally invasive surgery, in which we present our literature reviews, conclusions, and practical recommendations for the use of specific port instruments, port site closure, and electrosurgical and ultrasonic techniques.

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A multidisciplinary evidence-based guideline for minimally invasive surgery: part 2—laparoscopic port instruments, trocar site closure, and electrosurgical techniques

et al. 2012

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Primary entry trocar design and entry-related complications at laparoscopy in obese patients: meta-analysis

et al. 2023

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Background Safe primary entry at laparoscopy could present challenges in obese patients. Various techniques have been proposed in previous studies, however, the characteristics of the actual device utilized may be more influential than the technique in achieving successful abdominal entry in patients with increased BMI. Methods This systematic review and meta-analysis included both randomized and non-randomized studies gathered with no date filters from MEDLINE, Embase, Scopus, Web of Science and Clinicaltrials.gov. PRISMA guidelines underpinned the conduct and reporting of the review. The meta-analysis of proportions was conducted using a generalized linear mixed model and analyses included random-effects models. The primary outcome was the proportion of first access vascular and visceral injuries incurred in the process of laparoscopic abdominal surgery in patients with a BMI >30 kg/m2. Subgroup analysis was performed for optical versus non-optically enabled devices. Results In total, 5403 patients were analysed across 13 observational studies with a mean BMI of 45.93 kg/m2. In 216 patients from two randomized studies, the mean BMI was 39.92 kg/m2. The overall incidence using a random-effects model was 8.1 per 1000 events of visceral and vascular injuries (95 per cent c.i. 0.003 to 0.024). Heterogeneity was statistically significant at I2 = 80.5 per cent (69.6 per cent; 87.5 per cent, P< 0.0001). In a subgroup analysis, a tendency towards reduced injuries when optical devices were employed was observed with one per 100 injuries in these trocars (95 per cent c.i. 0.001 to 0.018) versus four per 100 (95 per cent c.i. −0.019 to –0.102) in non-optically enabled devices. Conclusion Injuries during primary laparoscopic entry undertaken in obese patient groups are uncommon. Due to considerable heterogeneity in the small number of examined studies, evidence was insufficient and largely of low quality to ascribe differences in the incidence of injuries to the characteristics of the primary entry trocar utilized.

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6 Therapiefehler

2011

Forensische Gynäkologie

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Guideline on preventing entry-related gynaecological laparoscopic injuries: post-publication reflections of the senior author

Cited by 3 publications

References 32 publications

A multidisciplinary evidence-based guideline for minimally invasive surgery: part 2—laparoscopic port instruments, trocar site closure, and electrosurgical techniques

A multidisciplinary evidence-based guideline for minimally invasive surgery: part 2—laparoscopic port instruments, trocar site closure, and electrosurgical techniques

Primary entry trocar design and entry-related complications at laparoscopy in obese patients: meta-analysis

6 Therapiefehler

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