[The advantage of an umbilical micro-laparotomy, "open laparoscopy", for laparoscopic surgery. Experimental study]

This study was carried out to evaluate the respective safety of standard introduction of the umbilical trocar after insuflation of the abdomen through a veress needle, direct trocar insertion, and the open laparoscopy approach. Abdominal adhesion were induced by standardized peritoneal trauma in 60 New Zeland white female rabbits. Three weeks later, the animals were randomly assigned to one of three techniques: group 1: standard approach; group 2: direct trocar insertion; group 3: open laparoscopy. Twenty-four bowel injuries occurred in group 1, thirty nine in group 2, and six in group 3. The differences between groups were statistically significant (group 1 vs group 2: p = 0.03; group 3 vs group 1: p = 0.004; group 3 vs group 2: p = 0.0001). These findings favor the use of the open laparoscopy approach when abdominal adhesions are suspected. The standard approach is safer than the technique without pneumoperitoneum, but would require an endoscopic visualization of the umbilical trocar insertion to reduce the complication rate.