Importance of Safe Access Technique in Laparoscopic Surgery
The main challenge facing the laparoscopic surgery is the primary abdominal access, as it is usually a blind procedure associated with vascular and visceral injuries. Complications associated with laparoscopy are often related to entry. The life-threatening complications include injury to the bowel, bladder, major abdominal vessels, and anterior abdominal-wall vessel. Other less serious complications can also occur, such as post-operative infection, subcutaneous emphysema and extraperitoneal insufflation. There is no clear consensus as to the optimal method of entry into the peritoneal cavity. It has been proved from studies that 50% of laparoscopic major complications occur prior to the commencement of the surgery. The surgeon must have adequate training and experience in laparoscopic robotic surgery before intending to perform any procedure independently. He /she should be familiar with the robotic equipments, instrument and energy source he intends to use. The incidence of complications according to different techniques used for inducing pneumoperitoneum in laparoscopic robotic surgery was studied.
Prospective and retrospective data was collected for (50) patients underwent laparoscopic surgery from September 2015 to September 2016 in World Laproscopy Hospital , all these patients were operated here using different entry techniques. Three hundred and sixty patients underwent laparoscopic surgery;. The operations included in our study were Totla laproscopic hysterectomy (254), diagnostic laparoscopy for infertility and abdominal pathology (56), ovarian cystectomy (20), diagnostic hysteroscopy(15), operative hysterscopy(13), sacrocolpopexy (2). The early complications recorded in our study are abdominal wall vascular injuries ,visceral injuries ,bradycardia , preperitoneal insufflations .The incidence of laproscopic entry related injuries in gynecological operations was 6.9% .But the incidence of laproscopic entry related injuries in major pelvic operations was 7.8%. Peritoneal insufflations by Co2 done by different entry techniques as follow; 1-veress trocar: used in (222) patients. 2-veress needle: used in (31) patients. 3-blunt trocar: used in (30) patients. 4-sharp trocar: used in (27) patients. 5-visiport: used in (20) patients. 6-palmer technique: (20) patients; used when the patients have umbilical scar . 7-Hasson technique: used in (10) patients.
CONCLUSION
There appears to be no evidence of benefit in terms of safety of one technique over another. However, the included studies are small and cannot be used to confirm safety of any particular technique. No single technique or instrument has been proved to eliminate laparoscopic entry associated injury. Proper evaluation of the patient, supported by good surgical skills and reasonably good knowledge of the technology of the instruments remain to be the cornerstone for safe access and success in minimal access surgery.
7 COMMENTS
Dr. Vinit Kumar
#1
Apr 27th, 2020 4:50 am
Excellent information of the Importance of Safe Access Technique in Laparoscopic Surgery. Excellent way of doing & demonstrating. Thanks.
Dr. Bijoy Paull
#2
May 18th, 2020 1:29 pm
! Absolutely brilliant lecture of Safe Access Technique in Laparoscopic Surgery. The way of you Explaining and demonstration the access technique really excellent. I have learn a lot.
Dr.Archan
#3
May 23rd, 2020 6:08 am
Awesome video of the importance of the Safe Access Technique in Laparoscopic Surgery.Thank you this is very helpful now have I a better understanding than before. Doctor Mishra you are a great teacher.
Dr. Mohammed Fatima
#4
Jun 11th, 2020 11:31 am
Thanks, Dr. Mishra for posting this amazing video of Laparoscopic Surgery. I watch your video regularly and I appreciate your work.
Dr. Manveer Singh
#5
Jun 16th, 2020 5:22 am
Such an excellent presentation. Excellent techniques. Thanks for uploading this video of Importance of Safe Access Technique in Laparoscopic Surgery
Dr. Naveen Chandra
#6
Jun 22nd, 2020 5:59 pm
Finally, I found a well-explained, well-defined, piece-by-piece information and easy-to-understand, Importance of Safe Access Technique in Laparoscopic Surgery one of my favorite topic! Thank you so much, Prof Dr. R. K. Mishra ...truly love and appreciate your simple yet thorough explanation!!!
Thanks for posting.
Thanks for posting.
Dr. Venkata Pawan Kumar
#7
Jun 22nd, 2020 6:09 pm
Thank you Dr. Mishra your explanation is really amazing and thanks for your great lecture on importance of safe access technique in laparoscopic Surgery,Thank you so much for explaining this concept so well! It really simplifies it and makes it actually really easy to understand! I appreciate you shared your valuable knowledge.
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