Three simple steps during closed laparoscopic entry may minimize major injuries

Vilos, George A.; Vilos, Angelos G.; Abu-Rafea, Basim; Hollett-Caines, Jackie; Nikkhah-Abyaneh, Zohreh; Edris, Fawaz

doi:10.1007/s00464-008-0060-4

Cited by 54 publications

(48 citation statements)

References 38 publications

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“…The correct position of the trocar can be checked with a 5 mm optic in cases of small operations or the entry site can be dilated to 10 mm after validation that there are no remarkable adhesions. Panoramic viewing reveals any pathological changes in the vicinity of the abdomen, e. g., in the intestines, liver, gallbladder, or spleen (7,11,(21)(22)(23).…”

Section: Closed-entry Technique Veress Needle Technique and Co 2 Gasmentioning

confidence: 99%

“…The different layers are easy to differentiate, and the peritoneum is pierced only after it has been ascertained that the abdominal wall is free of adherent bowel. (18,23,28,29). Endopath TM (Ethicon, Johnson & Johnson; New Brunswick, NJ, USA) has a cannula-integrated thread design that provides greater abdominal wall retention and minimal trocar slip-outs.…”

Section: Entry Under Visionmentioning

confidence: 99%

See 1 more Smart Citation

Abdominal anatomy in the context of port placement and trocars

Alkatout¹,

Mettler²,

Maass³

et al. 2015

J Turkish German Gynecol Assoc

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Review 241Introduction Extra-abdominal relevant anatomy Anatomical basis: The anterior abdominal wall has four muscles that are penetrated at all entries: rectus abdominis, external obliquus abdominis, internal obliquus abdominis, and transversus abdominis. Although the penetrating areas are variable in laparoscopy, the usual trocar placement uses similar inserting areas. Therefore, it is obligatory for any surgeon to be experienced in the anatomy of the abdominal wall and its consecutive relevant anatomical structures. There are no significant vascular structures that need to be respected upon insertion of the subumbilical trocar. Solely, strict attention has to be given to holding to the median line to avoid any accidental damage to paramedian structures. There are two arteries in the superficial abdominal wall that should be visualized. Damage to these arteries should be avoided because even superficial incisions can lead to severe bleeding that requires the conversion from laparoscopy to laparotomy. Both vessels can be visualized by diaphanoscopy (Figures 1-4). Trocar placement is performed, dependent on the corresponding internal site, at a 90° angle to the abdominal wall once the aiming point has been located. The superficial epigastric artery arises from the femoral artery approximately 1 cm below the inguinal ligament through the fascia cribrosa, turns upward in front of the inguinal ligament, and then ascends while spreading out between the two layers of the superficial fascia of the abdominal wall, nearly as far as the umbilicus. The circumflex iliac superficial artery originates from the femoral artery close to the superficial epigastric artery. After perforating the fascia lata, it runs parallel to the inguinal ligament and laterally to the iliac crist while spreading into smaller branches (1). Places for trocar insertionThe laparoscope and optic trocar should be inserted, whenever possible, in the subumbilical region using a semilunar or straight incision (Figure 1). Only if trocar placement is not possible, e.g., due to severe adhesions or large intra-abdominal tumors, are alternative entry sites negotiated, e.g., above the umbilicus or Palmer's point (Figure 5), as a precursor entry site.The placement for the working trocars depends on the operation. If the operative focus is located in the pelvis and no large tumor is expected to be touching the umbilical region, the two working trocars can be inserted in the lower abdominal wall in a vessel-free area, as confirmed by diaphanoscopy. Any auxiliary trocar can be placed in the midline suprasymphysically or left of the midline. A maximum distance between the optic trocar and the working trocars should be Although the anatomy of the human being has not changed, technical developments in operating materials and methods demand a simultaneous development in operative management. Developments in electronic and optical technologies permit many gynecological operations to be performed laparoscopically. One fundamental distinction between any other operating...

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Section: Closed-entry Technique Veress Needle Technique and Co 2 Gasmentioning

confidence: 99%

Section: Entry Under Visionmentioning

confidence: 99%

Abdominal anatomy in the context of port placement and trocars

Alkatout¹,

Mettler²,

Maass³

et al. 2015

J Turkish German Gynecol Assoc

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show abstract

“…Böylelikle abdominal kaviteye girildi¤i anlafl›l›r (14) . Kardiyovasküler fonksiyonlar› etkilemeyecek geçici yüksek intraperitoneal bas›nc›nda güvenli girifli sa¤layaca¤› vurgulanm›flt›r (38) .…”

Section: G‹r‹fiunclassified

Different Access Areas, Access Techiques and Trocar Types in Transperitoneal Laparoscopy

Bozkurt¹,

Yumru²

2013

J Turk Soc Obstet Gynecol

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(1,2) . Bundan baflka laparoskopik cerrahinin laparatomik cerrahiye oranla daha az komplikasyon h›z›na sahip oldu¤una dair veriler mevcuttur (3,4) . Laparoskopik cerrahinin relatif güvenli olmas›na ra¤men istenmeyen ciddi ba¤›rsak, mesane ve vasküler hasara neden olmas›, komplike ekipmanlar gerektirmesi ve uzun ö¤renme e¤risi kullan›m›n› k›s›tlamaktad›r (5,6) . Ciddi komplikasyonlar›n ço¤u trokar yerleflimi ile iliflkilidir (7,8) . Bu DIFFERENT ACCESS AREAS, ACCESS TECHNIQUES AND TROCAR TYPES IN TRANSPERITONEAL LAPAROSCOPY SUMMARYLaparoscopy has enabled a radical change of practice for surgeons over the last two decades. In general, laparoscopic surgery leads to less scarring, less postoperative pain and more rapid healing rates compared to laparotomy (1,2) . Data are also available indicating that laparoscopic surgery has lesser complication rates compared to laparotomic surgery (3,4) . Although laparoscopic surgery is relatively safe, its causes unwanted and severe intestinal, bladder and vascular injury, requiring complicated equipment and a long learning curve limit is required for surgeons to master its use (5,6) . Most of the severe complications are related to trocar insertion (7,8) .

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“…Although laparoscopic approach is currently the choice to perform common abdominal surgeries [1] [2] [3], its use requires creation of a pneumoperitoneum by any of the four already described techniques. That is, 1) classic closed technique with a Veres needle through the umbilicus, 2) Palmer closed technique, with a Veres needle through the left hypochondrium, 3) Hasson or open technique, which involves entering the cavity through a minilaparotomy incision, or 4) Direct technique, inserting a port through the abdominal wall without previous insufflation.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Incidence of Complications among the Different Techniques of Laparoscopic Approach: Experience in a General Surgery Service in a Private Hospital

Valdez-Durón¹,

Fernandez-Alvarez²,

González-Chávez³

et al. 2018

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Introduction: At least four techniques or approaches to minimize the risk of injury have been introduced. The correlation between techniques and the complication rate is controversial. The objective of the study is to report the incidence of laparoscopic entry associated injury, in relation to the used technique. Material and Methods: A retrospective study was conducted at the Hospital Español, in a 12-month period (2013). The medical records of all patients who underwent laparoscopic surgery were reviewed. Demographic and surgical variables were analyzed, comparing the results statistically through an analysis of variance (ANOVA). Results: A total of 792 cases were analyzed. The surgeries performed were: cholecystectomies (42%), appendectomies (26%), diagnostic laparoscopies (20%), ventral or inguinal hernioplasty (9%) and fundoplications (3%). The preferred approach was Hasson's (79%) and Veres's needle technique (14%), followed by classic closed (14%) and Palmer technique (2%). We documented six cases of laparoscopic entry associated injury (0.76%), four associated with the Hasson technique, one with Veress's needle technique and one with direct approach technique were reported. The statistical analysis was performed considering the different techniques and their relation with the injuries. Analysis of variance did not reach statistical significance (p = 0.31). Conclusions: Among our data, the number of laparoscopic entry associated injuries, was less than 1%, and has a similar frequency to the reported literature. We did not find significant differences between the four laparoscopic entry techniques. There remains no clear eviHow to cite this paper: Valdez-Durón, M., Fernández-Álvarez, J., González-Chávez, A.M.,

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Three simple steps during closed laparoscopic entry may minimize major injuries

Abstract: (1) A VIP-Pressure (<10 mmHg) indicates intraperitoneal placement of the Veress needle. (2) The use of transient HIP-Entry does not adversely affect cardiopulmonary function in healthy women. (3) Visual cannula offers an additional step towards safer entry.

Cited by 54 publications

References 38 publications

Abdominal anatomy in the context of port placement and trocars

Abdominal anatomy in the context of port placement and trocars

Different Access Areas, Access Techiques and Trocar Types in Transperitoneal Laparoscopy

Comparison of the Incidence of Complications among the Different Techniques of Laparoscopic Approach: Experience in a General Surgery Service in a Private Hospital

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