Laparoscopic entry techniques

Abstract

An open-entry technique is associated with a significant reduction in failed entry when compared to a closed-entry technique, with no difference in the incidence of visceral or vascular injury.Significant benefits were noted with the use of a direct-entry technique when compared to the Veress Needle. The use of the Veress Needle was associated with an increased incidence of failed entry, extraperitoneal insufflation and omental injury; direct-trocar entry is therefore a safer closed-entry technique.The low rate of reported complications associated with laparoscopic entry and the small number of participants within the included studies may account for the lack of significant difference in terms of major vascular and visceral injury between entry techniques. Results should be interpreted with caution for outcomes where only single studies were included.

Total Laparoscopic Hysterectomy in Obese and Morbidly Obese Women

“…The laparoscopic entry phase is the biggest challenge because of the displacement of the umbilicus till the pubis and the thickness of the subcutaneous fat tissue [8]. However, the frequency of vascular or visceral injury does not differ according to the entry technique used, as reported in the 2012 Cochrane review; however, this review did not consider the effect of BMI on laparoscopic entry [18]. Entry technique guidelines published in 2008 suggest the use of a Palmer's point or open technique in morbidly obese patients [19].…”

Difficulties of Bariatric Surgery after Abdominoplasty

“…The primary trocar is placed without prior insufflation. This technique avoids the risks associated with Veress needle but it may increase the risk of major vessel injury [8, 9]. The main problem encountered during abdominoplasty patients seems to be perforation of fibrotic tissue.…”

Bladeless Direct Optical Trocar Insertion in Laparoscopic Procedures on the Obese Patient

“…Recently Ahmad et al 3 identified 13 different laparoscopic-entry techniques from 28 randomized controlled studies. Indeed numbers of entry techniques are multiplying even faster in consideration of the state-of-the-art updates, which are consistently retooling operating theaters, and surgical technique modifications, but abdominal entry is always hazardous when obese patients are in the surgical room.…”

“…Of the techniques currently being used, none has been identified as being safe enough to prevent complications associated with laparoscopic entry. 3 …”