Routine use of open technique in laparoscopic operations

Area of Science:

• Minimally Invasive Surgery
• Surgical Techniques
• Patient Safety

Background:

• Blind insertion of Veress needle and closed trocar placement in laparoscopy risk major vascular/visceral injury.
• Open technique offers an alternative for insufflation, especially in patients with abdominal scars.
• This study evaluates the routine use of the open technique in laparoscopic surgery.

Purpose of the Study:

• To assess the safety and efficacy of the routine open technique for pneumoperitoneum in laparoscopic procedures.
• To compare complication rates between open and closed techniques for trocar insertion.
• To determine the incidence of major vascular and visceral injuries associated with the open technique.

Main Methods:

• Prospective evaluation of 330 patients undergoing laparoscopic procedures using the routine open technique.
• Data collection on conversion rates, reasons for conversion, and postoperative complications.
• Analysis of complications specifically related to trocar insertion and pneumoperitoneum.

Main Results:

• Conversion to laparotomy was necessary in 7.6% of cases (25/330), primarily due to unclear biliary anatomy or minor hemorrhage.
• 13 minor postoperative complications (3.6%) occurred in 11 patients, unrelated to trocar insertion.
• No major vascular or visceral injuries were observed, highlighting the safety of the open technique.

Conclusions:

• Routine open technique for pneumoperitoneum is highly effective in preventing severe trocar-related complications.
• The open technique is a safe alternative to blind needle insertion, minimizing risks associated with laparoscopic abdominal procedures.
• This method represents a best practice for preventing avoidable surgical injuries during laparoscopic surgery.