Laparoscopic peritoneal entry preferences among Canadian gynaecologists

To understand current laparoscopic entry practices among Canadian gynaecologists and to raise awareness of patient safety in accordance with the Society of Obstetricians and Gynaecologists of Canada clinical practice guideline, "Laparoscopic Entry: A Review of Techniques, Technologies, and Complications," published in May 2007.

A national survey was designed to determine different laparoscopic entry methods used by practising gynaecologists, to determine entry locations, and to gather information about mishaps. The survey was translated into French for francophone practitioners. In total, the survey was forwarded to 590 SOGC members.

Of 269 responses (a 45.6% response rate), 224 responses were from obstetrician-gynaecologists who identified themselves as currently practising laparoscopy. Seventy-five percent of these respondents reported that they had read the SOGC laparoscopic entry guideline. There was no significant difference in practice patterns when comparing geographic practice location, gender, and number of years in practice. For laparoscopy in an unscarred abdomen, the most common entry method is Veress needle insufflation with closed trocar entry (78.9%). When adhesions are suspected, only 25.4% utilize the left upper quadrant. Of respondents, 28.7% use an insufflation pressure of 20-25 mm Hg.

Our survey had a significant response rate and was able to delineate current laparoscopic entry practice patterns of gynaecologists, which were consistent across Canada. Despite 72.9% of respondents reporting familiarity with the recent SOGC clinical practice guideline, it appears that clinical practice does not necessarily coincide with current recommendations. These variances in gynaecological practice emphasize the need for further educational initiatives to ensure that the evidence from research is used to make clinical practice safer.