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Reduction of cannula-related laparoscopic complications using a radially expanding access device
D I Galen1, A Jacobson, L N Weckstein
1Reproductive Science Center of the Bay Area, San Ramon, CA 94583, USA.
Study Objective:
To determine the safety of a new radially expanding access device compared with complication rates associated with sharp laparoscopic cannulas.
Design:
Prospective, multicenter study (Canadian Task Force classification II-1).
Setting:
Free-standing and hospital-based ambulatory surgery centers.
Patients:
Two hundred twelve women undergoing various laparoscopic procedures and followed over 44 months.
Intervention:
Five hundred forty-one radially dilating access devices were used exclusively for laparoscopic abdominal wall access.
Measurements And Main Results:
No major vascular injury, abdominal wall bleeding, intestinal injury, bladder or ureteral injury, liver trauma, or postoperative incisional hernia occurred. One patient developed a postoperative mesenteric hematoma probably caused by a venous injury from the Veress needle. Of the 541 radially expanding access cannulas placed, only 6 (1%) slipped, despite absence of fascial anchoring devices.
Conclusion:
Radially dilating abdominal access devices may reduce laparoscopic complications, lessen a surgeon's exposure to liability, and improve patient outcomes while reducing facility costs. (J Am Assoc Gynecol Laparosc 6(1):79-84, 1999)