Complete evidence regarding major vascular injuries during laparoscopic access

Area of Science:

• Minimally Invasive Surgery
• Surgical Safety
• Gastrointestinal Surgery

Background:

• Previous reports indicated insufficient evidence on open versus closed laparoscopy safety regarding major injuries.
• Concerns exist regarding vascular and visceral injury rates during laparoscopic procedures.

Purpose of the Study:

• To compare the safety of open and closed laparoscopy concerning major vascular and visceral injury rates.
• To evaluate the relative risk of complications associated with different laparoscopic entry techniques.

Main Methods:

• A prospective/retrospective review of 5900 open laparoscopies was conducted.
• A meta-analysis of published literature on open and closed laparoscopy injury rates was performed.
• Medicolegal and manufacturer device reports were also analyzed for injury data.

Main Results:

• Open laparoscopy in the case series resulted in zero major vascular and one visceral injury.
• Meta-analysis showed 0.044% major vascular injury rate for closed laparoscopy versus 0% for open laparoscopy (P=0.003).
• Visceral injury rates were 0.07% for closed and 0.05% for open laparoscopy (P=0.18).

Conclusions:

• Open laparoscopy eliminates the risk of major vascular injury.
• Open laparoscopy demonstrates a reduced rate of major visceral injuries compared to closed laparoscopy.
• The Hasson cannula technique for open laparoscopy is recommended as the preferred method for peritoneal access.