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WJOLS
WJOL S
10.5005/jp-journals-10033-1250
Comparison of Open and Closed Entry Techniques for Creation of Pneumoperitoneum in Laparoscopic Surgery
RESEARCH ARTICLE
Comparison of Open and Closed Entry Techniques for
Creation of Pneumoperitoneum in Laparoscopic Surgery in
Terms of Time Consumption, Entry-related Complications
and Failure of Technique
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1 Muzzafar Zaman, Samita Singal, Rikki Singal, Aliya Shah, Karamjot Singh Sandhu, Bir Singh
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7 Aadhar Khera, Sagar Bassi
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ABSTRACT required to induce pneumoperitoneum, total operating time,
air leakage and injuries sustained during induction of pneumo
The modern art of examining the abdominal cavity by laparos peritoneum were compared in both techniques.
copy and its contents which requires insertion of a cannula
through abdominal wall, creation of pneumoperitoneum and Result: Out of the total 200 patients included in study, 100
visualization of abdominal cavity to perform any surgical proce were in group A and 100 in group B. Mean time required for
dure has become a routine in many institutions. The first step in successful pneumoperitoneum was 9.17 minutes in group A
any laparoscopic procedure is creation of pneumoperitoneum and 8.11 minutes in group B. Total operating time ranged
for which mostly carbon dioxide is the recommended gas used. from 55 minutes to 130 minutes in group A and from 45 to 110
Two commonly used methods to create pneumoperitoneum minutes in group B. Mean of total operating time was 78.34
are closed (veress needle) and open technique (Hasson tech and 67 minutes in groups A and B respectively. Mean time
nique). Both have their own advantages and disadvantages. needed to close the wound was 9.88 minutes in group A and
The current study was designed to compare these two tech 4.97 minutes in group B. Failure of technique was noted in
niques in terms of safety of the procedure, time for induction of three patients in group A while no failure was experienced in
pneumo peritoneum, air leakage, and time required to complete group B. Air leakage was seen in five patients in group B and
the procedure. none in group B. In two cases in group A minor complications
Aim: To compare the open and closed methods of creating during creation of pneumoperitoneum were observed while
pneumoperitoneum for doing various laparoscopic procedures in group B no complication occurred. Port site infection and
in terms of their safety, operating time and other parameters. port site hernia was seen in group B and none in group A. No
patient died in the study. Two patients were having preperitoneal
Settings and design: A prospective randomized double blind insufflation which was presented as injury due to induction of
study. pneumoperitoneum.
Materials and methods: This was a randomized controlled
prospective study conducted at Department of General and Conclusion: We concluded from this study that open technique
minimal access surgery, MMIMSR Medical College, Ambala of pneumoperitoneum was, less time consuming and safer than
Haryana from August 2013 to December 2015. Pneumoperi the closed technique.
toneum was created by closed technique in group A, and by Keywords: Hasson’s technique, Laparoscopic cholecystec
open technique in group B. Time required for successful pneu tomy, Pneumoperitoniem, Veress needle.
moperitoneum was calculated in each group. Failure to induce
pneumoperitoneum was determined for each technique. Time How to cite this article: Zaman M, Singal S, Singal R, Shah A,
Sandhu KS, Singh B, Khera A, Bassi S. Comparison of Open
and Closed Entry Techniques for Creation of Pneumoperitoneum
in Laparoscopic Surgery in Terms of Time Consumption, Entry
1,2 Assistant Professor, Professor, Postgraduate related Complications and Failure of Technique. World J Lap
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5 Senior Resident Postgraduate Resident Surg 2015;8(3):6971.
1,3,5,7,8 Department of Surgery, Maharishi Markandeshwar
Institute of Medical Sciences and Research, Ambala, Haryana Source of support: Nil
India
Conflict of interest: None
2 Department of Radiology,Maharishi Markandeshwar Institute
of Medical Sciences and Research, Ambala, Haryana, India
INTRODUCTION
4 Department of Microbiology,Maharishi Markandeshwar Institute
of Medical Sciences and Research, Ambala, Haryana, India The existence of numerous methods for the induction of
6 Department of Surgery, Gain Sagar Medical and Hospital pneumoperitoneum at laparoscopy surgery indicates that
Banur, Punjab, India none have been proven totally efficacious or complica-
Corresponding Author: Muzzafar Zaman, Assistant tion free. These methods include the standard or closed
Professor, Maharishi Markandeshwar Institute of Medical technique of insufflation after insertion of the Veress
Sciences and Research, Ambala, Haryana, India, Phone: needle via the umbilicus (infra or supra umbilical), open
8059931554, email: muzzafarzaman@yahoo.com
laparoscopy involving dissection through the linea alba
World Journal of Laparoscopic Surgery, September-December 2015;8(3):69-71 69
