[Open laparoscopy for prevention of puncture injuries]

Perforating lesions occurring during the establishment of the pneumoperitoneum using the Veres needle and blind introduction of the camera trocar are among the major complications of laparoscopic surgery. Even when all the necessary safety measures are observed and despite complete mastery of the technique, this complication cannot be completely avoided during the blind procedure. The technique of open laparoscopy, so-called, with the introduction of a blunt trocar under direct vision is the sole alternative available for the prevention of such injuries. The advantages of this procedure are that, with appropriate practice, it takes no longer, can be employed in all possible situations, including previous surgery, and, in particular, when assisting a surgeon who is in the process of gaining experience in laparoscopic surgery. Severe perforating injuries and their sequelae are often advanced as an argument against the use of laparoscopic surgical procedures. Through the use of open laparoscopy, injuries to blood vessels and viscera can be virtually completely eliminated, and patient safety considerably improved. On the basis of our own experience, we can unreservedly recommend open laparoscopy as the routine approach for all laparoscopic interventions.