An open access technique to create pneumoperitoneum in laparoscopic surgery

Area of Science:

• Laparoscopic Surgery
• Surgical Techniques
• Minimally Invasive Procedures

Background:

• An open access technique via the umbilical cicatrix tube aims to minimize vascular and visceral injuries during laparoscopic surgery.
• This method is designed for routine use, prioritizing ease, safety, and broad applicability for surgeons in patients without prior midline incisions.

Purpose of the Study:

• To prospectively evaluate the efficacy of the open access technique in 100 consecutive laparoscopic operations.
• Key metrics include time to abdominal access, surgeon experience, and patient body mass index (BMI).

Main Methods:

• A midline incision was made within the umbilical cicatrix tube, extending into the linea alba.
• Peritoneal penetration allowed insufflation, followed by insertion of a blunt trocar.

Main Results:

• Median access time was 93 seconds, with no significant difference between patients with BMI >30 (100 sec) and BMI <30 (90 sec).
• Consultants achieved faster access (median 88 sec) compared to residents (median 120 sec, p=0.003).
• No instances of gas leakage were observed; prolonged access occurred in three cases due to equipment failure or patient obesity.

Conclusions:

• The open access technique is a viable and safe option for all patients undergoing laparoscopic procedures without a prior midline incision.
• The technique is characterized by its speed, ease of learning, and minimal associated complications.