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Muzzafar Zaman et al 10.5005/jp-journals-10033-1268
REVIEW ARTICLE

Complications as a Result of Entry Techniques for creating

Pneumoperitoneum and Recommendations to minimize
Them in Laparoscopic Surgery: A Review of Literature

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1 Muzzafar Zaman, Rajneesh K Mishra, Rikki Singal, Aliya Shah, Bhanu Pratap Sharma
ABSTRACT Numerous new techniques, technologies, and guidelines
have been introduced to eliminate/decrease the risks
It is an evidence-based fact that laparoscopic surgery is superior associated with entry techniques in laparoscopy. The two
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to conventional open surgery. Any laparoscopic surgical major entry techniques widely carried out include the closed
procedure has many advantages for the patients, health care technique (Veress) and open technique (Hasson). The other
system, and society, although it is not devoid of disadvantages. techniques employed include use of direct trocar insertion,
Advantages of Minimal Access Surgery use of disposable shielded trocars, radially expanding trocars,
Minimal access surgery often offers better visualization than and visual entry systems. No single method or equipment has
conventional surgery, particularly better visualization of the been proven to eliminate laparoscopic entry-associated injury.
hiatus and deep structures in the pelvis. Materials and methods: A systematic electronic search was
• Laparoscopic surgery offers dramatic advantages in terms conducted and various articles were studied and reviewed and
of the quality of life after the operation. this review article was prepared.
• Postoperative pain is less, which decreases postoperative Keywords: Complications, Entry, Laparoscopy, Trocars.
analgesic (narcotic) use and its complications. This also aids
in lower respiratory complications. How to cite this article: Zaman M, Mishra RK, Singal R, Shah A,
• Smaller wounds are associated with fewer wound complica- Sharma BP. Complications as a Result of Entry Techniques
tions, less scarring, and better cosmesis. for creating Pneumoperitoneum and Recommendations
• Laparoscopic procedure results in reduction of postoperative to minimize Them in Laparoscopic Surgery: A Review of
adhesions. Literature. World J Lap Surg 2016;9(1):38-40.
• Patients stay in the hospital for a shorter period and recover Source of support: Nil
faster.
• Patients are able to return to their normal activities faster Conflict of interest: None
(e.g., feeding, school, office).
Disadvantages of Minimal Access Surgery INTRODUCTION
• Operating time is longer. Minimal Access Surgery (MAS) is a specialized form of
• The complication rate is higher during the learning curve of surgery that allows surgeons to operate without making
the procedure.
• Loss of tactile sensation occurs. large incisions as are done in conventional (open) surgery.
• With current technology, the video camera can provide only As laparoscopy is carried out with the help of small
a two-dimensional image, although three-dimensional views incisions, patients have less postoperative pain, spend
are becoming available. shorter time in the hospital, and recover significantly
• Controlling bleeding laparoscopically is difficult. faster than after open surgery. Access into the abdomen
• The number of instruments and angles in which they can is associated with injuries to the gastrointestinal tract or
be applied are limited. Robotic applications using wrist
technology is improving this problem. major blood vessels, and 50% of these complications occur
before the beginning of the surgery. The majority of these
injuries are due to insertion of primary umbilical trocar.
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1 Assistant Professor, Chief, Professor, Postgraduate Increased morbidity and mortality result when surgeons
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Student, Postgraduate do not recognize injuries early and do not address them
1,3 Department of General Surgery, MM Institute of Medical quickly. Methods of primary trocar insertion are split
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Sciences and Research, Ambala, Haryana, India between “open” and “closed” techniques.
2 World Laparoscopy Hospital, Gurgaon, Haryana, India To minimize entry-related injuries, several techniques,
4 Department of Microbiology, MM Institute of Medical Sciences instruments, and approaches have been introduced in
and Research, Ambala, Haryana, India recent years.
5 Department of Surgery, MM Institute of Medical Sciences and
Research, Ambala, Haryana, India Common Entry Complications during Mas
Corresponding Author: Muzzafar Zaman, Assistant Professor
Department of General Surgery, MM Institute of Medical The three main complications during creation of pneu-
Sciences and Research, Ambala, Haryana, India, Phone moperitoneum in MAS are bowel injuries, vascular
+918059931554, e-mail: muzzafarzaman@yahoo.com
injuries, and urological injuries. Up to 50% of all major
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