Page 6 - Jourmal of World Association of Laparoscopic Surgeon

Shailesh Kumar et al

injury and gas embolism and reduces the risk of bowel injury 2. Jansen FW, Kolkman W, Bakkum EA, de Kroon CD, Trimbos-
and recommend the open technique to be adopted for Kemper TCM, Trimbos JB. Complications of laparoscopy: An
primary laparoscopic entry. 26 inquiry about closed versus open-entry technique. Am J Obstet
Gynecol 2004;190;634-38.
Argesta favors direct trocar insertion in nonobese patient 3. Hashizume M, Sugimachi K. Needle and trocar injury during
rather than Veress needle insertion as if has a higher laparoscopic surgery in Japan. Surg Endosc 1971;11:1198-201.
feasibility rate and is associated with fewer minor compli- 4. Hasson HM. Open laparoscopy as a method of access in
cations but seems to be no different in both techniques laparoscopic surgery. Gynaecol Endosc 1999;8:353-62.
regarding the major complications. 10 5. Moberg AC, Montgomery A. Primary access related compli-
cations with laparoscopy. Surg Endosc 2005;19:1196-99.
In a retrospective analytical, multicentric study conducted 6. Samsal PK, Tantia O, Jain M, et al. Primary access related
by Muhammad Sajid et al to evaluate closed technique for complications in laparoscopic cholecystectomy via the closed
creating pneumoperitoneum in terms of procedural safety technique: Experience of a single surgical team over more than
on 5,244 patients undergoing laparoscopic surgery, authors 15 years. Surg Endosc 2009;23:2407-15.
concluded that closed technique using Veress needle for 7. Merlin TL, Hiller JE, Maddern JG, Jamieson GG, Brown AR,
Kolbe A. Systemic review of the safety and effectiveness of
creating pneumoperitoneum is as safe as Hasson’s technique methods used to establish pneumoperitoneum in laparoscopic
23
and no method has advantage over the other. Merlin et al surgery. Br J Surg 2003;90:668-79.
reported in a systematic review of the various methods used 8. Neudecker J, Sauerland S, Nengebauer F, et al. The European
by general surgeons and gynecologists to establish access Association for Surgery Clinical Practice Guidelines on the
for laparoscopic surgery that risk of bowel injury in pneumoperitoneum for laparoscopic surgery. Surg Endosc
2002;16:1121-43.
nonrandomized studies was higher with the open technique 9. Philips PA, Amaral FA. Abdominal access complications in
than with closed technique, although bias introduced laparoscopic surgery. J Am Coll Surg 2001;192:525-36.
through patient selection may have been a factor. 7 10. Argresta F, DeSimone P, Ciardo LF, Bedin N. Direct trocar
Chapron et al in a nonrandomized comparison of open insertion vs Veress needle in nonobese patients undergoing
laparoscopic procedures. Surg Endosc 2004;18:1778-81.
versus closed laparoscopic entry concluded that open 11. Palmer R. Safety in laparoscopy. J Reprod Med 1974;13:1-5.
laparoscopy does not reduce the risk of major complications 12. Schoonderwoerd L, Swark DJ. The role of optical access trocars
during laparoscopic access. 24 in laparoscopic surgery. Surg Technol Int 2005;14:61-67.
Hasson had concluded that there is no evidence to 13. McKernan JB, Finley CR. Experience with optical trocar in
support abandoning the closed entry technique in performing laparoscopic procedures. Surg Laparosc Endosc
Percutan Tech 2002;12:96-99.
laparoscopy; however, the selection of patients for an open 14. Garry R. Towards evidence based laparoscopic entry techniques:
or alternative procedure is still recommended. 25 Clinical problems and dilemmas. Gynaecol Endosc1999;8:
Jansen et al, Gary and most of the gynecologists continue 315-26.
to use closed laparoscopic entry and concluded that none 15. Viols GA, Vilos AG, Abu-Rafea B, et al. Three simple steps
of the method is superior or inferior to others. 2,14,15 during closed laparoscopic entry may minimize major injuries.
Surg Endosc 2009;23:758-64.
It is not only the technique of primary access to 16. Rosen DM, Lam AM, Chapman M, Cario GM. Methods of
abdominal cavity that matters in respect of the complications creating pneumoperitoneum: A review of techniques and
but also the other factors like proper selection of patients, complications. Obstet Gynecol Surv 1998;53(3):167-74.
BMI, history of previous abdominal surgeries, obesity and 17. Schafer M, Lauper M, Krahenbuhl L. Trocar and Veress needle
lastly the expertize of the surgeons. injuries during laparoscopy. Surg Endosc 2001;15:275-80.
18. Champault G, Cazacu F, Taffinder N. Serious trocar accidents
in laparoscopic surgery: A French survey of 103,852 operations.
CONCLUSION
Surg Endosc 1996;6:367-70.
Based on the above mentioned discussion we conclude that 19. Jared L, Bhoyrul S, Mathew E, Mark A, Nayan D. Safe and
the Veress needle technique of primary access is quiet Rapid laparoscopic access-a new approach. World J Surg 2005;
29:800-03.
comparable or even superior to open one in terms of primary 20. Bonjer HJ, Hazebrek EJ, Kazemier G, Giuffrida MC, Meijer WS,
access related complications. It is recommended that Veress Lange JF. Open vs closed establishment of pneumoperitoneum
needle technique is still a safe, easy and cost effective in laparoscopic surgery. Br J Surg 1997;84:599-602.
technique, but surgeon must continue with the primary 21. Sigman HH, Fried GM, Garzon J, Hinchey EJ, Wexler MJ,
access technique in which they feel more comfortable and Meakins JL, et al. Risk of blind versus open approach to
confident. celiotomy for laparoscopic surgery. Surg Laparosc Endosc
1993;3:296-99.
22. Ballem RV. Technique of pneumoperitoneum. Surgical Lap
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