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Wildey B, Berman D, Borahay MA. Cardiovascular collapse during laparoscopy: a brief overview. Arch Gynecol Obstet 2024; 309:2253-2256. [PMID: 38015208 DOI: 10.1007/s00404-023-07274-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/18/2023] [Indexed: 11/29/2023]
Abstract
This review article considers the physiology, differential diagnosis and immediate management of vasovagal response, vascular injury and carbon dioxide embolism caused during the creation of the laparoscopic pneumoperitoneum. These pathologies account for over half of all laparoscopic complications and therefore, by taking a systematic approach to these possibly life-threatening events, laparoscopy can become even safer.
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Affiliation(s)
- Brian Wildey
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 4940 Eastern Avenue Room A121, Baltimore, MD, 21224-2780, USA.
| | - David Berman
- Department of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Mostafa A Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 4940 Eastern Avenue Room A121, Baltimore, MD, 21224-2780, USA
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Rizzuto A, Bozzarello C, Andreuccetti J, Amaddeo A, Iannello AM, Sagnelli C, Cirocchi R, Cuccurullo D, Pignata G, Corcione F. Transumbilical laparoscopy for pneumoperitoneum establishment: a comprehensive multicentre evaluation affirming safety, feasibility, and a range of clinical benefits. Front Surg 2024; 11:1390038. [PMID: 38712337 PMCID: PMC11070471 DOI: 10.3389/fsurg.2024.1390038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
Introduction Transumbilical laparoscopy (TUL) has emerged as a promising technique for establishing pneumoperitoneum in laparoscopic cholecystectomy, offering potential safety, feasibility, and clinical benefits. This retrospective multicentre study aims to evaluate the efficacy and outcomes of TUL in the management of gallbladder diseases. Methods A retrospective analysis was conducted on a cohort of 2,543 patients who underwent TUL between 2011 and 2021 across various medical institutions in Italy. Data collection included demographic, clinical, intraoperative, and postoperative parameters. Standardized protocols were followed for preoperative and postoperative management. The TUL technique involved precise anatomical incision and trocar placement. Results The study demonstrated favorable outcomes associated with TUL, including a low conversion rate to open surgery (0.55%), minimal intraoperative complications (0.16%), and short hospital stays (average 2.4 days). The incidence of incisional hernias was notably low (0.4%). Comparison with existing literature revealed consistent findings and provided unique insights into the advantages of TUL. Discussion Despite limitations, such as the absence of a control group and the retrospective nature of the study, the findings contribute valuable insights to the literature. They inform surgical decision-making and advance patient care in laparoscopic cholecystectomy for gallbladder diseases. Conclusion Transumbilical laparoscopy shows promise as a safe and feasible technique for establishing pneumoperitoneum in laparoscopic cholecystectomy. The study's findings support its clinical benefits, including low conversion rates, minimal complications, and short hospital stays. Further research, including prospective studies with control groups, is warranted to validate these results and optimize patient outcomes.
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Affiliation(s)
- Antonia Rizzuto
- Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Cristina Bozzarello
- Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | | | - Angela Amaddeo
- Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | | | - Carlo Sagnelli
- Department of General, Mininvasive and Robotic Surgery, Colli Monaldi Hospital, Naples, Italy
| | - Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Diego Cuccurullo
- Department of General, Mininvasive and Robotic Surgery, Colli Monaldi Hospital, Naples, Italy
| | - Giusto Pignata
- Department of General Surgery, Civil Hospital of Brescia, Brescia, Italy
| | - Francesco Corcione
- Department of General Surgery, Federico II University Hospital, Naples, Italy
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Agarwal PK, Golmei J, Goyal R, Maurya AP. Comparison Between Closed and Open Methods for Creating Pneumoperitoneum in Laparoscopic Cholecystectomy. Cureus 2023; 15:e35991. [PMID: 36911586 PMCID: PMC10004421 DOI: 10.7759/cureus.35991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 03/12/2023] Open
Abstract
Background: To study the efficacy of closed and open methods for creating pneumoperitoneum in laparoscopic cholecystectomy by comparing the two in terms of their outcome and complication. Study Design: Single-centre, prospective, observational study. Materials and study: Purposive sampling method where the inclusion criteria were all patients with cholelithiasis who were advised and consented to laparoscopic cholecystectomy of age 18-70 years were included in the study group. Exclusion criteria include patients with a paraumbilical hernia, a history of upper abdominal surgery, uncontrolled systemic illness, and local skin infection. Sixty cases of cholelithiasis satisfying exclusion and inclusion criteria who underwent elective cholecystectomy during the study period were included. Thirty-one of these cases underwent the closed method, while in the remaining 29 patients open method was adopted. Cases in which pneumoperitoneum created by closed technique were grouped as group A and those by open technique as group B. Parameters comparing the safety and efficacy of the two methods were studied. The parameters were access time, gas leak, visceral injury, vascular injury, need for conversion, umbilical port site hematoma, umbilical port site infection, and hernia. Patients were assessed on the first postoperative day, the seventh postoperative day, and then two months after surgery. Some follow-ups were done telephonically. Results: Out of 60 patients, 31 underwent the closed method, while 29 underwent the open method. Minor complications like gas leak during the procedure was observed more in the open method. The mean access time in the open-method group was less than in the closed-method group. Other complications like visceral injury, vascular injury, need for conversion, umbilical port site hematoma, umbilical port site infection, and hernia were not observed in either group during the allocated follow-up period in the study. Conclusion: Open technique for pneumoperitoneum is as safe and effective as the closed technique.
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Affiliation(s)
- Puneet K Agarwal
- General Surgery, All India Institute of Medical Sciences Bhopal, Bhopal, IND
| | - Jason Golmei
- General Surgery, All India Institute of Medical Sciences Bhopal, Bhopal, IND
| | - Richa Goyal
- Obstetrics and Gynecology Surgery, Dr. Agarwal Clinic, Jalesar, IND
| | - Ajeet P Maurya
- General Surgery, All India Institute of Medical Sciences Bhopal, Bhopal, IND
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Chaves KF, Apple AN, Johnson JC, Jesse NJ, Yunker AC. Abdominal Wall Thickness at Palmer's Point and Distance to Adjacent Structures Across the Body Mass Index Spectrum. J Minim Invasive Gynecol 2022; 29:848-854. [PMID: 35306223 DOI: 10.1016/j.jmig.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE Studies delineating left upper quadrant (LUQ) anatomy across a range of body mass indices are lacking. We aimed primarily to compare, between non-obese and obese women, abdominal wall thickness and the distance from the LUQ to key structures. Additionally, we aimed to characterize LUQ anatomy in underweight women. DESIGN A retrospective cohort study. SETTING A tertiary academic medical institution. PATIENTS Sixty women (30 non-obese, 30 obese) age 18 and older who underwent abdominal imaging from 10/1/2018 through 12/31/2018. INTERVENTIONS Computed tomography imaging of the chest, abdomen, and pelvis. MEASUREMENTS AND MAIN RESULTS Abdominal wall thickness at the LUQ was significantly greater in obese (4.3 ± 1.7 cm) as compared to non-obese patients (2.4 ± 1.7 cm) (p<.001), as were distances to all key structures (aorta, vena cava, spleen, stomach, pancreas, liver, left kidney, pelvis) (p≤.02). On average, all structures, with the exception of stomach and liver, were >10 cm (the length of a typical insufflation needle) away from the LUQ insertion point in obese women. In underweight women, the aorta, spleen, stomach, pancreas, and liver were all within 10 cm of the LUQ insertion point. Within the obese and non-obese group, abdominal wall thickness at the LUQ was significantly greater than at the umbilicus (p<.001). Body mass index (BMI) was more strongly correlated with abdominal wall thickness at the LUQ (r=0.84, p<.001) than at the umbilicus (r=.69, p<.001) (p=.007 for comparison). CONCLUSION This study highlights special anatomic considerations for LUQ access in obese and underweight patients. In obese women, abdominal wall thickness may be greater at this site than at the umbilicus and the liver and stomach remain within reach of an insufflation needle. The increased working distance from the LUQ to the pelvis in obese patients may necessitate specialized instruments if this site is used during surgery. In underweight women, the aorta, in addition to many other structures, is within reach of commonly used entry devices.
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Affiliation(s)
- Katherine F Chaves
- Vanderbilt University Medical Center, Department of Obstetrics and Gynecology, B1106 Medical Center North, 1211 21(st) Ave South, Nashville, TN 37212, Vanderbilt University Medical Center, Nashville, TN.
| | - Annie N Apple
- Vanderbilt University School of Medicine, Eskind Family Biomedical Library and Learning Center, 2209 Garland Ave, Nashville, TN 37232
| | - Julia C Johnson
- Vanderbilt University Medical Center, Department of Obstetrics and Gynecology, B1106 Medical Center North, 1211 21(st) Ave South, Nashville, TN 37212, Vanderbilt University Medical Center, Nashville, TN
| | - Nicholas J Jesse
- Vanderbilt University Medical Center, Department of Obstetrics and Gynecology, B1106 Medical Center North, 1211 21(st) Ave South, Nashville, TN 37212, Vanderbilt University Medical Center, Nashville, TN
| | - Amanda C Yunker
- Vanderbilt University Medical Center, Department of Obstetrics and Gynecology, B1106 Medical Center North, 1211 21(st) Ave South, Nashville, TN 37212, Vanderbilt University Medical Center, Nashville, TN
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Watrowski R, Kostov S, Alkatout I. Complications in laparoscopic and robotic-assisted surgery: definitions, classifications, incidence and risk factors - an up-to-date review. Wideochir Inne Tech Maloinwazyjne 2021; 16:501-525. [PMID: 34691301 PMCID: PMC8512506 DOI: 10.5114/wiitm.2021.108800] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022] Open
Abstract
Almost all gynecological and general-surgical operations are - or can be - performed laparoscopically. In comparison to an abdominal approach, the minimally invasive access offers several advantages; however, laparoscopy (both conventional and robotic-assisted) can be associated with a number of approach-specific complications. Although the majority of them are related to the laparoscopic entry, adverse events may also occur due to the presence of pneumoperitoneum or the use of laparoscopic instruments. Unfortunately, a high proportion of complications (especially affecting the bowel and ureter) remain unrecognized during surgery. This narrative review provides comprehensive up-to-date information about definitions, classifications, risk factors and incidence of surgical complications in conventional and robotic-assisted laparoscopy, with a special focus on gynecology. The topic is discussed from various perspectives, e.g. in the context of stage of surgery, injured organs, involved instruments, and in relation to malpractice claims.
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Affiliation(s)
- Rafał Watrowski
- St. Josefskrankenhaus, Teaching Hospital of the University of Freiburg, Freiburg, Germany
| | - Stoyan Kostov
- Department of Gynecology, Medical University Varna, Varna, Bulgaria
| | - Ibrahim Alkatout
- Department of Gynecology and Obstetrics, Kiel School of Gynecological Endoscopy, University Hospitals Schleswig-Holstein, Kiel, Germany
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Modified Intraumbilical Versus Infraumbilical Entry Method at Laparoscopy: A Cohort Study. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2021; 32:21-27. [PMID: 34420006 DOI: 10.1097/sle.0000000000000983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/29/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is no consensus on the optimal laparoscopic entry method. Whether a transumbilical or periumbilical incision is beneficial for the initial peritoneal access has been debated. These 2 methods have their own advocates, since each has its own benefits and disadvantages. Furthermore, the lack of consensus extends to the type of entry technique [Hasson, Veress needle (VN), direct trocar]. We have conducted a study comparing a modified intraumbilical technique (MIT), a novel method that combines a VN insertion through a modified direct-trocar access, with the standard infraumbilical VN technique. Our aim is to determine which technique is a better route for the initial umbilical trocar. MATERIALS AND METHODS A retrospective cohort study of 406 patients from a prospectively maintained database has been performed. Two cohorts of cases have been analyzed (VN=198; MIT=208). Primary outcomes were intraoperative access-related events, entry failure, and long-term wound complications. Clinical follow-up was performed at 1 and 6 months and yearly thereafter. RESULTS Subcutaneous emphysema, extraperitoneal insufflation, and difficult entry (>2 VN insertions) occurred more frequently in the VN group (P=0.011, 0.023, and 0.023, respectively). There were 5 (2.52%) failed entries in the VN group and none in the MIT group (P=0.085). Regarding postoperative complications, seroma of the wound occurred more frequently in the VN group (P=0.033). At a mean follow-up of 18.4 months, 13 (3.20%) trocar-site hernias were detected, equally distributed among both groups. CONCLUSIONS MIT eliminates the risk of failed entries and some complications associated with the VN technique without an increase in umbilical wound infection and facilitates a proper closure of the umbilical incision to secure a low trocar-site hernia rate. Halfway between open and closed techniques for laparoscopic entry, MIT is a safe and feasible procedure that embodies the advantages of both methods and may constitute an advantageous alternative to the infraumbilical VN entry approach.
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Alhajress GI, Al Babtain I, Alsaghyir A, Arishi H. Complications of Veress Needle Versus Open Technique in Abdominal Surgeries. Cureus 2021; 13:e14926. [PMID: 34123625 PMCID: PMC8187055 DOI: 10.7759/cureus.14926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction In any laparoscopic procedure, the first and most important step is abdominal entry. This is followed by the creation of pneumoperitoneum, which is essential for lifting the abdominal wall off of the internal organs and visualizing the entered space. However, the entry and establishment of pneumoperitoneum are not without risks and complications, the most serious of which include vascular injuries and bowel perforations in all the different techniques used. The most commonly used techniques for abdominal entry are the closed (Veress) and open (Hasson) techniques, the choice of which varies according to the surgeon’s preference and other regional and local factors. Aim To compare the outcomes between the open technique and the Veress needle for accessing the peritoneum during laparoscopic surgery. Methodology This was a retrospective cohort study that aimed to compare the outcomes between the Veress needle and the open technique for entering the peritoneum in laparoscopic surgeries. A chart review was used as an instrument to collect data. The study was conducted in King Abdul-Aziz Medical City, Riyadh, Saudi Arabia. All patients who underwent abdominal laparoscopic surgery from 2006 to 2016 were included. Results We analyzed 365 patients who underwent laparoscopic abdominal surgery. The mean age of the patients was 32.6 years. The most common postoperative complication occurring during the admission period was abdominal pain (40.5%). Postoperative complications during admission were significantly associated with the type of needle used (χ2=10.641; p=0.001). Conclusion The type of technique used for entry and peritoneal access was associated with the occurrence of postoperative complications in abdominal surgeries. Thus, the choice of open or Veress technique for peritoneal access should be individualized based on factors such as patient sex, clinical diagnosis, and most importantly, the surgeons’ experience and preference.
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Affiliation(s)
- Ghassan I Alhajress
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU.,College of Medicine, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Ibrahim Al Babtain
- Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, SAU
| | - Abdullah Alsaghyir
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU.,College of Medicine, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Hassan Arishi
- Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, SAU
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Brenner-Anidjar RD, Rojo-Novo S, Frías-Sánchez Z, Montaño-Serrano M, Pantoja-Rosso FJ, Terracina D, Pantoja-Garrido M. Palmer's test usefulness in the correct positioning of the Veress needle and the reduction of complications during laparoscopic access maneuvers. J Obstet Gynaecol Res 2021; 47:576-582. [PMID: 33118305 DOI: 10.1111/jog.14544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/31/2020] [Accepted: 10/18/2020] [Indexed: 11/28/2022]
Abstract
AIM Abdominal cavity access accounts for 50% of complications during laparoscopic surgery. Different safety maneuvers have been used to try to diminish these. Our study aims to establish the usefulness of Palmer's test in the correct positioning of the Veress needle and the reduction of complications during laparoscopic access maneuvers, when used in addition to the determination of intraabdominal pressure. METHODS Prospective observational analytic multi-centered cohort study with 370 patients undergoing gynecologic laparoscopy between July 2014 and November 2019, comparing the additional use of Palmer's test in 185 patients (Palmer-Test-Yes, PTY), with intraabdominal pressure determination alone in 185 patients (Palmer-Test-No, PTN). RESULTS Intergroup homogeneity was described for the basic characteristics of both population samples, except for mean age and percentage of previous laparotomy. A total of 19 complications were recorded, 10 in PTY and 9 in PTN, with no significant differences (P = 0.814). No differences were found in the analysis of these complications, except for the rate of conversion to laparotomy, which occurred four times in the PTY group and none in PTN (P = 0.044). Furthermore, no differences were found once fixed for the history of previous laparotomy (P = 514.), nor for the percentage of successful access after the first attempt between both groups (P = 0.753). CONCLUSION Palmer's test, when used in addition to intraabdominal pressure determination, has not shown to be effective in preventing failed access to abdominal cavity or reducing complications associated with access maneuvers with the Veress needle. Hence, its systematic use is not justified, since it could generate a sense of false security.
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Affiliation(s)
| | - Sara Rojo-Novo
- Gynecology and Obstetrics, Virgen Macarena University Hospital, Seville, Spain
| | - Zoraida Frías-Sánchez
- Gynecology and Breast Pathology Unit, Virgen del Rocio University Hospital, Seville, Spain
| | - María Montaño-Serrano
- Gynecology and Obstetrics Unit, Hospitalet Hospital and Quiron Salud-Barcelona Hospital, Autonoma University of Barcelona, UAB, Barcelona, Spain
| | | | - Dan Terracina
- Department of Surgery and Cancer, Imperial College London, London, UK
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Anderson SJ, Fransson BA. Complications related to entry techniques for laparoscopy in 159 dogs and cats. Vet Surg 2019; 48:707-714. [PMID: 31087681 DOI: 10.1111/vsu.13230] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/24/2019] [Accepted: 04/14/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report the frequency and risk factors of complications related to 3 entry techniques for laparoscopy in small animals. STUDY DESIGN Single-institution retrospective case series. ANIMALS 159 client-owned dogs and cats. METHODS Medical records were reviewed for dogs and cats undergoing laparoscopic surgery with carbon dioxide (CO2 ) insufflation between 2006 and 2018. Data including entry site, entry technique, signalment, body conformation, complications, and operating surgeon/resident were analyzed by univariate regression analysis. Factors with P < .25 were included in multivariate regression analysis. RESULTS Complications occurred in 33 of 159 (21%) surgeries and were considered minor (CO2 leaks, omental insufflation, repeated entry) in 30 of 33 (91%) cases. The Ternamian visual entry, modified Hasson, and Veress needle entry techniques were associated with complications in 7 (9%), 17 (26%), and 9 (60%) surgeries, respectively. Major complications occurred in 3 of 159 (2%) surgeries, in which entry-related hemorrhage prompted conversion to an open technique (2 [13%] entries with Veress needle) and 1 [1%] with the Ternamian visual). Entry location and entry technique remained significant in the final multivariate model. Complications were 11.7 times more likely after a paramedian entry than after a midline entry; the odds ratio of complications were 5 and 28 times higher after modified Hasson and Veress needle entries, respectively, than after Ternamian visual entry. CONCLUSION In this study, a Ternamian visual entry technique and midline entry site appeared associated with fewer complications than 2 other techniques. CLINICAL SIGNIFICANCE The findings in this study are preliminary, and superiority of any entry technique must be reevaluated in a prospective randomized controlled study.
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Affiliation(s)
- Scott J Anderson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington
| | - Boel A Fransson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, Washington
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Zhang R, Xu Z, Yao J, Shi R, Zhang D, Mei Y, Zhong Y, Lai M, Wang L. Tuberculous peritonitis diagnosed using laparoscopy with assistance of a central venous catheter. Exp Ther Med 2018; 16:5265-5271. [PMID: 30542484 DOI: 10.3892/etm.2018.6854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 03/10/2017] [Indexed: 12/12/2022] Open
Abstract
Laparoscopy with peritoneal biopsy is a tool for rapid and accurate diagnosis of tuberculous peritonitis (TBP). However, laparoscopic procedures are not risk-free; complications include injuries to the gastrointestinal tract and major blood vessels. The purpose of the present study was to introduce a novel method for safe and straightforward laparoscopic diagnosis of TBP. A case series of 12 patients with TBP diagnosed between October 2012 and November 2013 at our hospital is presented. The patients underwent a novel method of laparoscopy involving the use of a central venous catheter (CVC). The diagnosis was confirmed by biopsy and histology. The efficacy of the method for TBP diagnosis was evaluated by the time taken for the procedure and the rate of successful completion. The safety of the method was evaluated by recording all intra- and post-operative adverse events encountered. The mean age of the patients was 41 years and 33% were male. The mean operation time was 50.6 min and the median duration of hospital stay was 7 days. In all cases, diagnostic laparoscopy was successfully performed. Targeted biopsies were taken from all of the patients and revealed caseous granulomatous inflammation. All patients tolerated the procedure without significant bleeding or digestive tract perforation. In conclusion, the present case series demonstrated a novel method of diagnostic laparoscopy with CVC that is a feasible and straightforward procedure for TBP diagnosis.
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Affiliation(s)
- Ru Zhang
- Department of Gastroenterology, Shenzhen People's Hospital, The Second Affiliated Hospital of Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Zhenglei Xu
- Department of Gastroenterology, Shenzhen People's Hospital, The Second Affiliated Hospital of Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Jun Yao
- Department of Gastroenterology, Shenzhen People's Hospital, The Second Affiliated Hospital of Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Ruiyue Shi
- Department of Gastroenterology, Shenzhen People's Hospital, The Second Affiliated Hospital of Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Dingguo Zhang
- Department of Gastroenterology, Shenzhen People's Hospital, The Second Affiliated Hospital of Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Yi Mei
- Department of Gastroenterology, Shenzhen People's Hospital, The Second Affiliated Hospital of Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Yunlian Zhong
- Department of Gastroenterology, Shenzhen People's Hospital, The Second Affiliated Hospital of Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Mingguang Lai
- Department of Gastroenterology, Shenzhen People's Hospital, The Second Affiliated Hospital of Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Lisheng Wang
- Department of Gastroenterology, Shenzhen People's Hospital, The Second Affiliated Hospital of Jinan University, Shenzhen, Guangdong 518020, P.R. China
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Mohammadi M, Shakiba B, Shirani M. Comparison of two methods of laparoscopic trocar insertion (Hasson and Visiport) in terms of speed and complication in urologic surgery. Biomedicine (Taipei) 2018; 8:22. [PMID: 30474603 PMCID: PMC6254099 DOI: 10.1051/bmdcn/2018080422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 07/23/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Nowadays, diverse approaches have been existed for laparoscopic procedures. The most common laparoscopic entry methods included close and direct entry laparoscopy and open (Hasson) laparoscopy. There is no evidence regarding the superiority in safety and initial speed for the use of open and optical laparoscopic entry. Therefore, the sight of current study was to evaluate comparative survey of two methods of laparoscopic trocar insertion (Hasson and VisiportTM) in terms of speed and complications in urologic surgery. METHODS This expertized base clinical trial study was conducted on 100 patients who underwent urological laparoscopy in Alzahra Hospital, Isfahan, Iran. These patients were randomly divided to two groups (n = 50). One group underwent open laparoscopy and another group Visiport optical trocar. Speed and Complications of urologic surgery was extracted from medical records. Independent T test was used for doing of analysis. RESULTS The mean age of patients in Hasson and Visiport laparoscopic group was 41.4 ± 11.2 and 41.6 ± 15 years old, respectively (p = 0.91). The mean time for initial trocar placement in patients who underwent Visiport trocar system and Hasson laparoscopic technique was 37.7 ± 15.59 and 95.4 ± 31.75 seconds. There was gratifying difference between two techniques of laparoscopic trocar insertion (Hasson and Visiport) in terms of speed (p = 0.000). In addition, complications were observed in 8% of patients who underwent Visiport trocar system. However, no complications were observed in Hasson laparoscopy group. CONCLUSION Visiport optical trocar technique is faster for initial trocar placement than open laparoscopy. However it is associated with complications compared to open laparoscopy. Therefore, there is evidence of benefit in terms of speed for initial trocar placement and harm based on complications in Visiport trocar system.
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Affiliation(s)
- Mehrdad Mohammadi
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Department of Urology, Isfahan University of Medical Sciences Isfahan Iran
| | - Behnam Shakiba
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Department of Urology, Isfahan University of Medical Sciences Isfahan Iran
| | - Matin Shirani
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Department of Urology, Isfahan University of Medical Sciences Isfahan Iran
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Bove P, Iacovelli V, Sandri M, Carilli M, Cindolo L, Autorino R, Kavoussi LR, Micali S, Porpiglia F, Rha KH, Kim FJ. Entry techniques in laparoscopic radical and partial nephrectomy: a multicenter international survey of contemporary practices. MINERVA UROL NEFROL 2018; 70:414-421. [DOI: 10.23736/s0393-2249.18.03075-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Abd Ellatif ME, Ghnnam WM, Abbas A, Basheer M, Dawoud I, Ellaithy R. Latif's point: A new point for Veress needle insertion for pneumoperitoneum in difficult laparoscopy. Asian J Endosc Surg 2018; 11:133-137. [PMID: 28856845 DOI: 10.1111/ases.12418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 06/26/2017] [Accepted: 07/19/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Creating pneumoperitoneum is the most challenging step during laparoscopy. The periumbilical area is the classic site for Veress needle insertion. We adopted a new access point for peritoneal insufflation. METHODS We introduced a new point for Veress needle insertion to create pneumoperitoneum during difficult laparoscopic procedures. The needle is placed between the xiphoid process and the right costal margin, and it then proceeds toward the patient's right axilla. We collected data to compare using this new method of peritoneal insufflation with using Palmer's point for pneumoperitoneum. RESULTS Since 2013, we have used this new technique in 570 patients (first group) and Palmer's point in 459 patients (second group). Among these patients, 196 patients (20%) had had previous abdominal operations, 98 patients (10%) had irreducible ventral hernia, and 735 patients (70%) were morbidly obese. The two groups were comparable in terms of patient characteristics. The mean time to create pneumoperitoneum in the first group was 0.8 ± 0.002 min compared to 1.08 ± 0.007 min in the second group (P ≤ 0.5). The mean number of punctures was 1.57 ± 1.02 in the first group compared to 2.9 ± 1.5 in the second group (P≤ 0.5); in the first group, 97% were successful on the first attempt entry, whereas this figure was 91% in second group. In the first group, the liver was punctured in 13 patients without any further complications; no other viscera were punctured. In the second group, gastric puncture occurred in 5 cases, transverse colon in 2 cases, and omental injury in 12 cases. CONCLUSION This new access point may represent a safe, fast, and easy way to create pneumoperitoneum, as well as a promising alternative to Palmer's point in patients who are not candidates for classic midline entry.
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Affiliation(s)
- Mohamed E Abd Ellatif
- Department of Surgery, Mansoura University Hospital, Mansoura, Egypt.,Department of Surgery, Hafr Albatin Central Hospital, Hafr Albatin, Saudi Arabia
| | - Wagih M Ghnnam
- Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - Ashraf Abbas
- Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - Magdy Basheer
- Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - Ibrahim Dawoud
- Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - Ramadan Ellaithy
- Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
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Harrington CM, Kavanagh DO, Tierney S, Deane R, Hehir D. Port insertion for minimally invasive surgery: a report of practices in the Irish Republic. Ir J Med Sci 2018; 187:1021-1027. [PMID: 29411293 DOI: 10.1007/s11845-017-1732-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND With rapidly evolving surgical technologies, minimally invasive surgery (MIS) has become the mainstay approach for many surgeons worldwide. As laparoscopic surgery was introduced in Ireland over two decades ago, we may be encountering a higher prevalence of related complications. AIMS This study aimed to gather data pertaining to risk factors for port-site herniation in MIS. METHODS A 14-point anonymous questionnaire was distributed electronically between January and May 2017 to consultant and trainee laparoscopists in the Republic of Ireland. This survey related to laparoscopic volume and surgical approaches to laparoscopic port-sites. RESULTS There were 172 eligible responses nationally. Approaches to peritoneal access included Hasson, veress (blind puncture) and SILS were 66.3, 32.6 and 1.2%, respectively. Senior surgeons and specialists in Obstetrics and Gynaecology (OBGYN) reported significantly higher utilisations of closed peritoneal access (p < 0.05). Of the participants, 119 (69.2%) reported using a bladeless trocar over a bladed type. Fascial closure was utilised in 94.2% of ≥ 10 mm and 2.3% of 5-mm ports using absorbable suture in 76.7%, non-absorbable suture in 14.5% and port closure devices in 8.7%. Perceptions of risk factors for PSH were not congruent with significant variations in responses between levels of expertise. CONCLUSIONS This study demonstrates significant variations in laparoscopic port-site practices amongst surgeons nationally. The new era of practitioners may benefit from evidence-based technical workshops and guidelines to increase awareness and reduce potential complications.
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Affiliation(s)
- Cuan M Harrington
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Dara O Kavanagh
- Department of General Surgery, Tallaght Hospital, Dublin, Ireland
| | - Sean Tierney
- Department of Vascular Surgery, Tallaght Hospital, Dublin, Ireland
| | - Richard Deane
- Department of Obstetrics and Gynaecology, Trinity College, Dublin, Ireland
| | - Dermot Hehir
- Department of Surgery, Midland Regional Hospital Tullamore, Arden Rd, Puttaghan, Tullamore, Co. Offaly, Ireland. .,University of Limerick GEMS, Limerick, Ireland.
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Djokovic D, Gupta J, Thomas V, Maher P, Ternamian A, Vilos G, Loddo A, Reich H, Downes E, Rachman IA, Clevin L, Abrao MS, Keckstein G, Stark M, van Herendael B. Principles of safe laparoscopic entry. Eur J Obstet Gynecol Reprod Biol 2016; 201:179-88. [DOI: 10.1016/j.ejogrb.2016.03.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Jain N, Sareen S, Kanawa S, Jain V, Gupta S, Mann S. Jain point: A new safe portal for laparoscopic entry in previous surgery cases. J Hum Reprod Sci 2016; 9:9-17. [PMID: 27110072 PMCID: PMC4817291 DOI: 10.4103/0974-1208.178637] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The present study was performed to assess the safety and feasibility of a new laparoscopic entry site in cases suspected of adhesions due to previous surgery. MATERIALS AND METHODS It is a retrospective study undertaken at a tertiary care referral center for advanced gynecological laparoscopic surgery from January 2011 to December 2014. RESULTS In 624 patients with a history of previous abdominal surgeries, the laparoscopic entry site was through a newly devised point. It is a point in the left paraumbilical region at the level of umbilicus, in a straight line drawn vertically upward from a point 2.5 cm medial to anterior superior iliac spine. Intra-abdominal adhesions were found in 487 (78.0%) patients, and umbilical adhesions in 404 (64.7%) patients with past abdominal surgeries. CONCLUSION There were no significant entry-related, intra-operative, or postoperative complications with the use of this entry point. It is also suitable as a main working port during the course of surgery.
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Affiliation(s)
- Nutan Jain
- Vardhman Infertility and Endoscopy Centre, Muzaffarnagar, Uttar Pradesh, India
| | - Sweta Sareen
- Vardhman Infertility and Endoscopy Centre, Muzaffarnagar, Uttar Pradesh, India
| | - Swati Kanawa
- Vardhman Infertility and Endoscopy Centre, Muzaffarnagar, Uttar Pradesh, India
| | - Vandana Jain
- Vardhman Infertility and Endoscopy Centre, Muzaffarnagar, Uttar Pradesh, India
| | - Sunil Gupta
- Vardhman Infertility and Endoscopy Centre, Muzaffarnagar, Uttar Pradesh, India
| | - Sonika Mann
- Vardhman Infertility and Endoscopy Centre, Muzaffarnagar, Uttar Pradesh, India
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Taye MK, Fazal SA, Pegu D, Saikia D. Open Versus Closed Laparoscopy: Yet an Unresolved Controversy. J Clin Diagn Res 2016; 10:QC04-7. [PMID: 27042535 DOI: 10.7860/jcdr/2016/18049.7252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 01/13/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Safe placement of the Verres needle or the primary trocar for establishment of pneumoperitoneum is the most critical step in laparoscopic procedure as it is associated with bowel, bladder and life threatening vascular injuries and embolism. In the last few decades many techniques and guidelines have been introduced to eliminate complications in creation of pneumoperitoneum. Classical closed technique (Verres needle) and the open classic technique (Hasson) are the most commonly used techniques for creation of pneumoperitoneum. AIM To compare the rate of occurrence and nature of complications in open and closed laparoscopy during establishment of pneumoperitoneum in different surgical and gynaecological procedures. MATERIALS AND METHODS This was a comparative study conducted at three hospitals in Dibrugarh district, Assam, India from January 2012 to December 2014. Total 3000 cases were included in the study with 1500 cases of open laparoscopy and 1500 cases of closed laparoscopy. Complications occurring in both the groups were compared by using Fisher's-exact test. RESULTS In closed laparoscopy group minor complications occurred in 80 (5.33%) and major complications in 20 (1.33%) cases. In open laparoscopy group minor complications were observed in 60 (4%) and major complications in 2 (0.13%). The p-value of the difference between the two groups for minor complications was 0.0834 and for major complications was 0.0001(significant). CONCLUSION Open laparoscopy was seen to be better than closed laparoscopy in terms of not only the rate of occurrence of complications but also the nature and severity of the complications. This study is clinically relevant as there is no consensus for a particular method of safe entry in to the peritoneal cavity warranting the need for more research. Open technique can be performed in all cases irrespective of previous operative scar, suspected intra peritoneal adhesions or obesity. Favourable outcome may be achieved in closed technique in cases of normal BMI, absence of postoperative scar in the abdomen, absence of abdominal and genital tuberculosis and pelvic inflammatory disease.
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Affiliation(s)
- Milan Kumar Taye
- Assistant Professor, Department of Obstetrics and Gynaecology, Assam Medical College & Hospital , Dibrugarh, Assam, India
| | - Syed Abul Fazal
- Associate Professor, Department of Surgery, Assam Medical College & Hospital , Dibrugarh, Assam, India
| | - David Pegu
- Assistant Professor, Department of Surgery, Assam Medical College & Hospital , Dibrugarh, Assam, India
| | - Dayanada Saikia
- Registrar, Department of Obstetrics and Gynaecology, Assam Medical College & Hospital , Dibrugarh, Assam, India
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Cuss A, Bhatt M, Abbott J. Coming to terms with the fact that the evidence for laparoscopic entry is as good as it gets. J Minim Invasive Gynecol 2014; 22:332-41. [PMID: 25460522 DOI: 10.1016/j.jmig.2014.10.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/27/2014] [Accepted: 10/30/2014] [Indexed: 02/07/2023]
Abstract
Entry to the peritoneal cavity for laparoscopic surgery is associated with defined morbidity, with all entry techniques associated with substantial complications. Debate over the safest entry technique has raged over the last 2 decades, and yet, we are no closer to arriving at a scientifically valid conclusion regarding technique superiority. With hundreds of thousands of patients required to perform adequately powered studies, it is unlikely that appropriately powered comparative studies could be undertaken. This review examines the risk of complications related to laparoscopic entry, current statements from examining bodies around the world, and the medicolegal ramifications of laparoscopic entry complications. Because of the numbers required for any complications study, with regard to arriving at an evidence-based decision for laparoscopic entry, we ask: is the current literature perhaps as good as it gets?
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Affiliation(s)
- Amanda Cuss
- Royal Hospital for Women, Sydney, Australia and University of New South Wales, Sydney, Australia
| | | | - Jason Abbott
- Royal Hospital for Women, Sydney, Australia and University of New South Wales, Sydney, Australia.
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Safety of Veress Needle Insertion in Laparoscopic Bariatric Surgery. Surg Laparosc Endosc Percutan Tech 2014; 24:e1-4. [DOI: 10.1097/sle.0b013e31828f6cfd] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Martin MJ. Comment on: Aortic injuries during laparoscopic gastric bypass for morbid obesity in Sweden 2009-2010: a nationwide survey. Surg Obes Relat Dis 2013; 10:207-9. [PMID: 24091056 DOI: 10.1016/j.soard.2013.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 06/26/2013] [Indexed: 11/20/2022]
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Angioli R, Terranova C, De Cicco Nardone C, Cafà EV, Damiani P, Portuesi R, Muzii L, Plotti F, Zullo MA, Panici PB. A comparison of three different entry techniques in gynecological laparoscopic surgery: a randomized prospective trial. Eur J Obstet Gynecol Reprod Biol 2013; 171:339-42. [PMID: 24103531 DOI: 10.1016/j.ejogrb.2013.09.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 08/12/2013] [Accepted: 09/12/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Laparoscopic entry techniques vary and still remain debated. We conducted a randomized control trial to compare three entry techniques. STUDY DESIGN Women aged 18-70 years, nominated for laparoscopic surgery at University of Rome Campus Bio-Medico, were randomized into three different groups: Veress needle (VER), Direct trocar insertion (DIR) and Open technique (OP). For each group, minor complications (extra-peritoneal insufflation, trocar site bleeding, omental injury and surgical site infection), failed entry and time of entry of the main trocar were evaluated. Major complications were also considered. Between-group comparisons were performed using chi-square test. Significance P value was <0.05. RESULTS A series of 595 consecutive procedures were included: 193 in the VER group, 187 in the DIR group and 215 in the OP group. Minor complications occurred in 36 cases: extraperitoneal insufflation (n=6) in the VER group only, site bleeding (n=2 in the VER group, n=2 in the DIR group and n=1 in the OP group), site infection (n=5 in the VER and n=6 in OP group), and omental injury (n=6 in the VER group and n=3 in the DIR group). Failed entry occurred in 4 cases of the VER group and 1 case of the DIR group. Mean time of entry was 212.4, 71.4 and 161.7s for the VER, DIR and OP groups respectively. Among major complications, one bowel injury resulted following the Veress technique. CONCLUSIONS In our series, DIR and OP entry presented a lower risk of minor complications compared with VER. In addition, time of entry was shorter in DIR than with OP entry.
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Affiliation(s)
- Roberto Angioli
- Department of Gynecology, University Campus Bio-Medico, Rome, Italy
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Comparison of two entry methods for laparoscopic port entry: technical point of view. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2012; 2012:305428. [PMID: 22761542 PMCID: PMC3384909 DOI: 10.1155/2012/305428] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 04/05/2012] [Indexed: 01/30/2023]
Abstract
Laparoscopic entry is a blind procedure and it often represents a problem for all the related complications. In the last three decades, rapid advances in laparoscopic surgery have made it an invaluable part of general surgery, but there remains no clear consensus on an optimal method of entry into the peritoneal cavity. The aim of this paper is to focus on the evolution of two used methods of entry into the peritoneal cavity in laparoscopic surgery.
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Abstract
The umbilicus is the main access route to the abdominal cavity in laparoscopic surgeries. However, its anatomical configuration is rarely studied in the surgical and anatomical literature. With introduction of laparoendoscopic single-site surgery and considering the significant number of primary and postoperative umbilical hernias, we felt the necessity to comprehensively study the umbilical structures and analyze their protective function against hernias. Twenty-four embalmed cadavers were studied in the anatomy laboratory of Case Western Reserve University. Round hepatic, median and medial ligaments, umbilical ring, umbilical and umbilicovesicular fasciae, and pattern of attachment to the ring were dissected and measured. Mean age was 82.1 years, ranging between 56 and 96 years, with a male-to-female ratio of 1.4:1. Ninety-two per cent was white and 8 per cent black adults. According to shape and attachment pattern of ligaments, umbilical ring is classified into five types. Hernia incidence was 25 per cent. All hernia cases lacked the umbilical fascia and the round hepatic ligament was not attached to the inferior border of the ring. The umbilical ring and its morphologic relation with adjacent ligaments are described and classified into five types. In contrary to sparse existing literature, we propose that umbilical fascia is continuation and condensation of umbilicovesicular rather than transversalis fascia. It was absent in cadavers forming conjoined median and medial ligaments with a single insertion site to the ring. Round ligament insertion to the inferior border of the ring provides another protective factor. These two protective measures were absent in all the observed umbilical hernias.
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Affiliation(s)
- Amir H. Fathi
- Departments of General Surgery, Case Western Reserve University and Case Medical Center, Cleveland, Ohio
| | - Hooman Soltanian
- Plastic Surgery, Case Western Reserve University and Case Medical Center, Cleveland, Ohio
| | - Alan A. Saber
- Departments of General Surgery, Case Western Reserve University and Case Medical Center, Cleveland, Ohio
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Abstract
BACKGROUND The Veress needle (VN) technique for establishing pneumoperitoneum in laparoscopic surgery is widely used and yet is associated with slow insufflation rates and potentially life-threatening complications. Although these complications have been rarely reported, they represent a major source of morbidity and mortality from laparoscopic procedures and a major reason for conversion to open surgery. The open laparoscopy (OL) is an alternative to the VN technique, being relatively safer, even if considered cumbersome by many authors. Recently, the direct trocar insertion (DTI) technique of establishing pneumoperitoneum has been reported as an alternative to both techniques, but it is largely confined to gynecologic procedures. We report a case-series study where we evaluate the patients who underwent a DTI entry for laparoscopy during a recent 5-year period, focusing attention on feasibility, safety, and the benefits of DTI. METHODS This is a case series of 2175 different laparoscopic procedures (1456 [66.9%] scheduled cases and 719 [33%] emergencies). In 2091 (96.1%) of them (1425 [68.1%] scheduled cases and 666 [31.8%] emergencies), pneumoperitoneum was established with DTI, either in the umbilicus or in Palmer's point. RESULTS There were no injuries, either minor or major. Peritoneal access and the creation of a laparoscopic workplace were obtained quickly and efficiently by DTI. CONCLUSION Our results suggest that DTI is a fast, safe, and reliable alternative to traditional techniques for pneumoperitoneum establishment and should be regarded as a part of the surgical armamentarium of a trained laparoscopic surgeon.
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Affiliation(s)
- F Agresta
- Unità Operativa Complessa di Chirurgia Generale, Ospedale Civile, Via Forlanini 71, Vittorio Veneto (TV), Italy.
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Compeau C, McLeod NT, Ternamian A. Laparoscopic entry: a review of Canadian general surgical practice. Can J Surg 2011; 54:315-20. [PMID: 21774882 DOI: 10.1503/cjs.011210] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Laparoscopic surgery has gained popularity over open conventional surgery as it offers benefits to both patients and health care practitioners. Although the overall risk of complications during laparoscopic surgery is recognized to be lower than during laparotomy, inadvertent serious complications still occur. Creation of the pneumoperitoneum and placement of laparoscopic ports remain a critical first step during endoscopic surgery. It is estimated that up to 50% of laparoscopic complications are entry-related, and most injury-related litigations are trocar-related. We sought to evaluate the current practice of laparoscopic entry among Canadian general surgeons. METHODS We conducted a national survey to identify general surgeon preferences for laparoscopic entry. Specifically, we sought to survey surgeons using the membership database from the Canadian Association of General Surgeons (CAGS) with regards to entry methods, access instruments, port insertion sites and patient safety profiles. Laparoscopic cholecystectomy was used as a representative general surgical procedure. RESULTS The survey was completed by 248 of 1000 (24.8%) registered members of CAGS. Respondents included both community and academic surgeons, with and without formal laparoscopic fellowship training. The demographic profile of respondents was consistent nationally. A substantial proportion of general surgeons (> 80%) prefer the open primary entry technique, use the Hasson trocar and cannula and favour the periumbilical port site, irrespective of patient weight or history of peritoneal adhesions. One-third of surgeons surveyed use Veress needle insufflation in their surgical practices. More than 50% of respondents witnessed complications related to primary laparoscopic trocar insertion. CONCLUSION General surgeons in Canada use the open primary entry technique, with the Hasson trocar and cannula applied periumbilically to establish a pneumoperitoneum for laparoscopic surgery. This surgical approach is remarkably consistent nationally, although considerably variant across other surgical subspecialties. Peritoneal entry remains an important patient safety issue that requires ongoing evaluation and study to ensure translation into safe contemporary clinical practice.
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Tinelli A, Malvasi A, Guido M, Tsin DA, Hudelist G, Stark M, Mettler L. Laparoscopy Entry in Patients With Previous Abdominal and Pelvic Surgery. Surg Innov 2011; 18:201-205. [DOI: 10.1177/1553350610393989] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Background: The background of this investigation is based on a common surgical problem: The access in laparoscopic surgery is more difficult in women with previous abdominopelvic surgery, since adhesions and viscera could be close to the point of trocar insertion. Purpose: The authors analyzed the safety and the efficacy of a modified direct optical entry (DOE) method versus the Hasson’s method by open laparoscopy (OL) in women with previous abdominopelvic surgery in a preliminary prospective case–control study. Materials and methods: A total of 168 women underwent laparoscopic surgery in university-affiliated hospitals: 86 were assigned to abdominal DOE (group A) and 82 to OL (group B). The main outcome measures were statistically compared: time required for entry into abdomen, blood loss, and occurrence of vascular and/or bowel injury. All patients had an intraperitoneal view of the primary port site during surgical procedure. Results: Statistical differences, in favor of the DOE group ( P < .01), were found in duration of entry and blood loss. The vascular and bowel injuries in OL versus DOE were not statistically different. Conclusions: Obtaining access to the peritoneal cavity in laparoscopic surgery is more difficult in patients with previous abdominopelvic surgery, since it can become a difficult, time-consuming, and occasionally hazardous procedure. The study results suggest that DOE is advantageous when compared with OL in terms of saving time enabling a safe and expeditious visually guided entry for laparoscopy.
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Affiliation(s)
| | | | | | | | - Gernot Hudelist
- Department of Gynecology and Obstetrics Wilhelminenspital der Stadt, Wien, Austria
| | - Michael Stark
- The New European Surgical Academy (NESA), Berlin, Germany
- The USP hospital, Mallorca, Spain
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Kumakiri J, Kikuchi I, Kitade M, Kuroda K, Matsuoka S, Tokita S, Takeda S. Incidence of Complications during Gynecologic Laparoscopic Surgery in Patients after Previous Laparotomy. J Minim Invasive Gynecol 2010; 17:480-6. [DOI: 10.1016/j.jmig.2010.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 03/03/2010] [Accepted: 03/07/2010] [Indexed: 10/19/2022]
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Laparoscopic Peritoneal Entry with the Reusable Threaded Visual Cannula. J Minim Invasive Gynecol 2010; 17:461-7. [DOI: 10.1016/j.jmig.2010.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 02/26/2010] [Accepted: 03/06/2010] [Indexed: 11/23/2022]
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Azevedo JLMC, Azevedo OC, Sorbello AA, Becker OM, Hypolito O, Freire D, Miyahira S, Guedes A, Azevedo GC. Intraperitoneal pressure and volume of gas injected as effective parameters of the correct position of the Veress needle during creation of pneumoperitoneum. J Laparoendosc Adv Surg Tech A 2010; 19:731-4. [PMID: 19792865 DOI: 10.1089/lap.2009.0080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this work was to establish reliable parameters of the correct position of the Veress needle in the peritoneal cavity during creation of pneumoperitoneum. METHODS The Veress needle was inserted into the peritoneal cavity of 100 selected patients, and a carbon-dioxide flow rate of 1.2 L/min and a maximum pressure of 12 mm Hg were established. Intraperitoneal pressure (IP) and the volume of gas injected (VG) were recorded at the beginning of insufflation and at every 20 seconds. Correlations were established for pressure and volume in function of time. Values of IP and VG were predicted at 1, 2, 3, and 4 minutes of insufflation, by applying the following formulas: IP = 2.3083 + 0.0266 x time +8.3 x 10(-5) x time(2) - 2.44 x 10(-7) x time(3); and VG = 0.813 + 0.0157 x time. RESULTS A strong correlation was observed between IP and preestablished time points during creation of the pneumoperitoneum, as well as between VG and preestablished time points during creation of the pneumoperitoneum, with a coefficient of determination of 0.8011 for IP and of 0.9604 for VG. The predicted values were as follows: 1 minute = 4.15; 2 minutes = 6.27; 3 minutes = 8.36; and 4 minutes = 10.10 for IP (mm Hg); and 1 minute = 1.12; 2 minutes = 2.07; 3 minutes = 3.01; and 4 minutes = 3.95 for VG (L). CONCLUSIONS Values of IP and VG at given time points during insufflation for creation of the pneumoperitoneum, using the Veress needle, can be effective parameters to determine whether the needle is correctly positioned in the peritoneal cavity.
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Affiliation(s)
- João L M C Azevedo
- Department of Surgery, Federal University of São Paulo, São Paulo, Brazil.
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Hypólito OHM, Azevedo JLMC, de Lima Alvarenga Caldeira FMS, de Azevedo OC, Miyahira SA, Miguel GPS, Becker OM, Machado ACCG, Filho GPN, Azevedo GC. Creation of pneumoperitoneum: noninvasive monitoring of clinical effects of elevated intraperitoneal pressure for the insertion of the first trocar. Surg Endosc 2009; 24:1663-9. [DOI: 10.1007/s00464-009-0827-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Accepted: 11/15/2009] [Indexed: 11/28/2022]
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