Abdominal access in gynaecological laparoscopy: a comparison between direct optical and blind closed access by Verres needle

Received 1 December 2008; received in revised form 13 May 2009; accepted 20 October 2009. published online 09 November 2009.

Abstract

Objective

: Complications associated with initial abdominal entry are a prime concern for laparoscopic surgeons. In order to minimize first access-related complications in laparoscopy, several techniques and technologies have been introduced in the past years. This investigation compares two laparoscopic access techniques.

Study design

: 194 women underwent laparoscopic surgery for simple ovarian cysts: 93 were assigned to direct optical access (DOA) abdominal entry (group I), and 101 women to classical closed method by Verres needle, pneumoperitoneum and trocar entry (group II). The following parameters were compared: time required for entry into abdomen, occurrence of vascular and/or bowel injury, blood loss. The results were analyzed using SAS software. p-value<0.05 was considered as significant.

Results

: No statistically significant differences were observed in the occurrence of blood loss and minor vascular injury between the two techniques, as well as minor bowel injuries; time for of abdominal entry, instead, were significantly reduced in the DOA group.

Conclusions

: The results of the preliminary comparison between the DOA and the Verres methods, commonly used by gynecologists, suggests that the visual entry system confers a statistical advantage over closed entry technique with Verres needle, in terms of time saving and due to the minor vascular and bowel injuries, thus enabling a safe and expeditious, visually-guided, entry for surgeons.

Keywords: Gynaecological laparoscopy, Laparoscopic entry, Laparoscopic procedure, First abdominal access, Direct optical access, Verres needle, Blind closed access, Laparoscopic complications

a Department of Obstetrics and Gynaecology, Vito Fazzi Hospital, Piazza Muratore, 73100 Lecce, Italy

b Department of Obstetrics and Gynaecology, Santa Maria Hospital, Bari, Italy

c Department of Gynaecology and Obstetrics, Division of Minimal Invasive endoscopy Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

d Department of Obstetrics and Gynaecology, LKH Villach, Austria

e The New European Surgical Academy (NESA), Berlin, Germany

f Kiel School of Gynaecological Endoscopy, Department of Obstetrics and Gynaecology, University Hospitals Schleswig-Holstein, Campus Kiel, Germany

Corresponding author. Tel.: +39 339 2074078; fax: +39 0832 661511.

PII: S0301-2115(09)00641-1

doi:10.1016/j.ejogrb.2009.10.025

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