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Related Experiment Videos

Laparoscopic entry techniques.

G Ahmad1, J M N Duffy, K Phillips

  • 1Stepping Hill Hospital, Obstetric & Gynaecology, 30 Badger Road, Altrincham, Cheshire, UK, WA14 5UZ. gaityahmad@hotmail.com

The Cochrane Database of Systematic Reviews
|April 22, 2008
PubMed
Summary
This summary is machine-generated.

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Comparing laparoscopic entry techniques reveals no single method is definitively safer for preventing major complications. Direct-trocar entry may reduce extraperitoneal insufflation and failed entries compared to Veress-Needle entry.

Area of Science:

  • Minimally Invasive Surgery
  • Gynecologic Surgery
  • Surgical Safety

Background:

  • Laparoscopic surgery is a common gynecologic procedure with potential entry-related complications.
  • Complications range from life-threatening injuries to less severe issues like infection and insufflation problems.
  • Optimal laparoscopic entry techniques remain debated.

Purpose of the Study:

  • To compare various laparoscopic primary-port-entry techniques.
  • To assess their impact on intra-operative and post-operative complications.

Main Methods:

  • Systematic review of randomized controlled trials (RCTs).
  • Searched MEDLINE and EMBASE databases up to July 2007.
  • Extracted data and analyzed results using odds ratios (Peto version) with 95% confidence intervals.

Related Experiment Videos

Main Results:

  • 17 RCTs involving 3,040 patients were analyzed.
  • No technique showed a clear advantage in preventing major complications.
  • Direct-trocar entry reduced extraperitoneal insufflation and failed entries versus Veress-Needle.
  • Radially expanding access system (STEP) trocar entry decreased trocar site bleeding compared to standard trocar entry.
  • Not lifting the abdominal wall before Veress-Needle insertion reduced failed entries.

Conclusions:

  • Current evidence does not support the superiority of any single laparoscopic entry technique regarding safety.
  • Included studies are small and limited, particularly excluding high-risk patients.
  • Further research is needed to confirm the safety of specific techniques.