Defining "laparoscopy" through review of technical details in JSLS

The term "laparoscopy" has lost some precision in its definition due to the proliferation in techniques of access to the abdominal cavity. Currently, procedures performed with radical differences in port size, placement, and even need for an extraction incision may be characterized as "laparoscopic." However, the general public and many insurers divide procedures in the simplified categories of laparoscopic or open. Our aim was to characterize the typical laparoscopic operation through review of the technical details of a year's worth of articles in JSLS.

We assembled and analyzed a database of all articles in JSLS from 2008-2009 (4 issues starting with Volume 12, #4). For comparison, we also reviewed articles from 1 decade ago (Volume 2). All procedural details were compiled, including means of access, number and size of ports, incision length, and conversion rates.

In the most recent year, there were 81 articles for analysis, compared to 39 in the earlier year. Few articles listed all technical details, as only 58% of reports described mode of access and 56% described the number of ports used. Access was nearly evenly divided between Hasson and Veress techniques. The average number of ports in both study periods was 4, although there was a trend toward smaller port sizes in the current year. Among those studies specifying incision length, the average was 6.1cm in both groups.

The technical operative details are lacking in many reports. Based on review of published studies, most procedures are done with 4 ports, 3 of which are ≥10mm in size. Until there is greater clarity in technical description, the precise definition of laparoscopy will remain elusive.