Entry technique for laparoscopy

The present trend in laparoscopic surgery is to make use of the Veress needle as an instrument for palpation of the abdominal cavity to secure "safe" blind introduction of the first trocar. The oxymoron is witness to the many mishaps experienced by the most daring surgeons who approach blindly each and every abdomen, irrespective of previous surgery. The "bayonet technique" heralded by the gynecological school oflaparoscopy has never been accepted by us, due to its inherent characteristic risk of injuries to the pelvic or retroperitoneal organs. Whenever the patient has had previous abdomino-pelvic surgery, the open laparoscopy technique is preferred with the Hasson's trocar either at the navel or at any other location, as deemed appropriate by the site of old incisions. Experience and laparoscopic findings have led us to enforce the principle that open laparoscopy should be instituted if any scar, even from previous Iaparoscopy, is present over the anterior abdominal wall. A variation in the technique for introduction of the Veress needle and safe execution of the pneumoperitoneum was devised to be used when the peritoneal cavity has not been violated surgically.