Laparoscopic entry: a review of Canadian general surgical practice

Abstract

Background: Laparoscopic surgery has gained popularity over open conventional surgery as it offers benefits to both patients and health care practitioners. Although the overall risk of complications during laparoscopic surgery is recognized to be lower than during laparotomy, inadvertent serious complications still occur. Creation of the pneumoperitoneum and placement of laparoscopic ports remain a critical first step during endoscopic surgery. It is estimated that up to 50% of laparoscopic complications are entry-related, and most injury-related litigations are trocar-related. We sought to evalu ate the current practice of laparoscopic entry among Canadian general surgeons. Methods:We conducted a national survey to identify general surgeon preferences for laparoscopic entry. Specifically, we sought to survey surgeons using the membership database from the Canadian Association of General Surgeons (CAGS) with regards to entry methods, access instruments, port insertion sites and patient safety profiles. Laparoscopic cholecystectomy was used as a representative general surgical procedure. Results:The survey was completed by 248 of 1000 (24.8%) registered members of CAGS. Respondents included both community and academic surgeons, with and without formal laparoscopic fellowship training. The demographic profile of respondents was consistent nationally. A substantial proportion of general surgeons (> 80%) prefer the open primary entry technique, use the Hasson trocar and cannula and favour the periumbilical port site, irrespective of patient weight or history of peritoneal adhesions. One-third of surgeons surveyed use Veress needle insufflation in their surgical practices. More than 50% of respondents witnessed complications related to primary laparoscopic trocar insertion. Conclusion:General surgeons in Canada use the open primary entry technique, with the Hasson trocar and cannula applied periumbilically to establish a pneumoperitoneum for laparoscopic surgery. This surgical approach is remarkably consistent nationally, although considerably variant across other surgical subspecialties. Peritoneal entry remains an important patient safety issue that requires ongoing evaluation and study to ensure translation into safe contemporary clinical practice.Contexte : La chirurgie laparoscopique a gagné en popularité par rapport à la chirurgie ouverte classique en raison des avantages qu'elle offre, tant pour les patients que pour les professionnels de la santé. Même si on reconnaît que le risque global de complications est moindre durant la chirurgie laparoscopique que durant la laparotomie, il survient parfois par inadvertance des complications graves. La création d'un pneumopéritoine et l'installation des dispositifs d'accès laparoscopiques demeurent une première étape cruciale lors de toute chirurgie endoscopique. On estime que jusqu'à 50 % des complications laparoscopiques sont liées à l'insertion et que la plupart des poursuites pour traumatisme mettent en cause une lésion causée par le trocart lui-même. Nous avons vo...

Multiple-, But Not Single-, Dose of Parecoxib Reduces Shoulder Pain after Gynecologic Laparoscopy

“…Therefore, laparoscopic surgery has revolutionized the practice of many surgical subspecialties over the past 2 decades 4. However, laparoscopic procedures are often associated with postlaparoscopic shoulder pain (PLSP), which may cause more discomfort to the patients than the pain at the incision sites 5.…”

Intraoperative safety of low pressure pneumoperitoneum cholecystectomy: a comparative study

“…Some are identified after the patient discharge from hospital, although the incidence is very low. 7 The complications include port-related direct organ injuries, such as abdominal organ or major and minor vascular injury; abdominal wall complications related to laparoscopic port insertion such as vascular injury, infection, and hernia; abdominal wall complications related to specimen removal, such as port site tumor seeding and endometriosis. [8][9][10][11][12] Probably no needle-trocar system can guarantee avoidance of injury during laparoscopic entry, especially when the trajectory of insertion puts great vessels at risk.…”

Trans umbilical laparoscopic access during laparoscopic procedures

“…[24,25] Through the use of the open technique vascular and visceral injuries can be virtually eliminated, significantly improving patient safety. [26] Lastly, the cosmetic effect of an umbilical incision is believed to be superior, as the scar is partially hidden by the umbilicus itself when depressed into its natural position.…”