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WJOL S
WJOLS

10.5005/jp-journals-10033-1257
Comparison between Different Entry Techniques in Performing Pneumoperitoneum in Laparoscopic Gynecological Surgery
REVIEW ARTICLE

Comparison between Different Entry Techniques in

Performing Pneumoperitoneum in Laparoscopic
Gynecological Surgery

Mandavi Rai

ABSTRACT safety of one technique over another. However, the included
studies are small and cannot be used to confirm safety of any
Background: The main challenge facing the laparoscopic particular technique. No single technique or instrument has
surgery is the primary abdominal access, as it is usually a blind been proved to eliminate laparoscopic entry-associated injury.
procedure associated with vascular and visceral injuries. Lapa- Proper evaluation of the patient, supported by good surgical
roscopy is a very common procedure in gynecology. Complica- skills and reasonably good knowledge of the technology of the
tions associated with laparoscopy are often related to entry. instruments remain to be the cornerstone for safe access and
The life-threatening complications include injury to the bowel, success in minimal access surgery.
bladder, major abdominal vessels, and anterior abdominal-
wall vessel. Other less serious complications can also occur, Keywords: Complications, Laparoscopy, Pnumoperitoneum,
such as postoperative infection, subcutaneous emphysema Trocar.
and extraperitoneal insufflation. There is no clear consensus
as to the optimal method of entry into the peritoneal cavity. It How to cite this article: Rai M. Comparison between Dif-
has been proved from studies that 50% of laparoscopic major ferent Entry Techniques in Performing Pneumoperitoneum
complications occur prior to the commencement of the surgery. in Laparos copic Gynecological Surgery. World J Lap Surg
The surgeon must have adequate training and experience in 2015;8(3):101-106.
laparoscopic surgery before intending to perform any proce- Source of support: Nil
dure independently. He should be familiar with the equipment,
instrument and energy source he intends to use. Conflict of interest: None
Materials and methods: A Literature review was performed
using PubMed, MedSpace, Springer Link and search engines INTRODUCTION
like Google and Yahoo. Following search terms were used:
trocar, laparoscopy, complications and pneumoperitoneum, The word laparoscopy originated from the Greek word
entery technique. A total of 10,000 citations were found. (Lapro—abdomen, scopion—to examine). Laparoscopy
Selected papers were screened for further references. Pub- is the art of examining the abdominal cavity and its
lications that featured illustrations and statistical methods of contents. This is achieved by sufficiently distending the
analysis are selected.
abdominal cavity (pneumoperitoneum) and visualizing
Results: Fifty-one articles were reviewed and the the opera- the abdominal contents using illuminated telescope.
tions included in our study were diagnostic laparoscopy for
infertility and abdominal pathology, ovarian cyst, total lapa- Over the past 50 years, rapid advancement in technology
roscopic hysterectomy, burch operation, myomectomy. The in terms of electronics, optical equipments and other
early complications recorded in our study are abdominal wall ancil lary ins truments, combined with improved surgical
vascular injuries, visceral injuries, bradycardia, preperitoneal proficiency and expertize, laparoscopic surgery rapidly
insufflations. The incidence of laparoscopic entry-related
injuries in gynecological operations was 6.9%. Overall, there advanced from a gynecological procedure for tubal steri­
was no evidence of advantage using any single technique in lization to one used in performing most of the surgical
terms of preventing major complications. However, there were procedures in all surgical and gynecological discipline
two advantages with direct trocar entry when compared with for a variety of indications.
Veress-needle entry, in terms of avoiding extraperitoneal
insufflation and failed entry. The main challenge facing the laparoscopic surgery
is the primary abdominal access, as it is usually a blind
Conclusion: On the basis of evidence investigated in this
review, there appears to be no evidence of benefit in terms of procedure associated with vascular and visceral injuries.
It has been proved from studies that 50% of laparoscopic
major complications occur prior to the commencement
1,2
Senior Resident of the surgery. If there is delay in diagnosis of visceral
Department of Obstetric and Gynecology, Max Super Speciality injuries or delay in reporting, the morbidity will increase
Hospital, Saket, New Delhi, India and may lead to mortality. 3
Corresponding Author: Mandavi Rai, Senior Resident The surgeon must have adequate training and experi­
Department of Obstetric and Gynecology, Max Super Speciality ence in laparoscopic surgery before intending to perform
Hospital, Saket, New Delhi, India, Phone: 9910873175, e-mail: any procedure independently. He should be familiar
mandavirai@ymail.com
with the equipment, instrument and energy source
World Journal of Laparoscopic Surgery, September-December 2015;8(3):101-106 101