Abstract
Objective
Laparoscopic entry techniques vary and still remain debated. We conducted a randomized
control trial to compare three entry techniques.
Study design: Women aged 18–70 years, nominated for laparoscopic surgery at University
of Rome Campus Bio-Medico, were randomized into three different groups: Veress needle
(VER), Direct trocar insertion (DIR) and Open technique (OP). For each group, minor
complications (extra-peritoneal insufflation, trocar site bleeding, omental injury
and surgical site infection), failed entry and time of entry of the main trocar were
evaluated. Major complications were also considered. Between-group comparisons were
performed using chi-square test. Significance P value was <0.05.
Results
A series of 595 consecutive procedures were included: 193 in the VER group, 187 in
the DIR group and 215 in the OP group. Minor complications occurred in 36 cases: extraperitoneal
insufflation (n = 6) in the VER group only, site bleeding (n = 2 in the VER group, n = 2 in the DIR group and n = 1 in the OP group), site infection (n = 5 in the VER and n = 6 in OP group), and omental injury (n = 6 in the VER group and n = 3 in the DIR group). Failed entry occurred in 4 cases of the VER group and 1 case
of the DIR group. Mean time of entry was 212.4, 71.4 and 161.7 s for the VER, DIR and OP groups respectively. Among major complications, one bowel
injury resulted following the Veress technique.
Conclusions
In our series, DIR and OP entry presented a lower risk of minor complications compared
with VER. In addition, time of entry was shorter in DIR than with OP entry.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Practice of endoscopic gynecologic surgery: a survey of Spanish gynecologists.Eur J Obstet Gynecol Reprod Biol. 2013; 169: 64-68
- Complications of laparoscopy: a prospective multicentre observational study.Br J Obstet Gynaecol. 1997; 104: 1419-1420
- Trocar-associated injuries and fatalities: an analysis of 1399 reports to the FDA.J Minim Invasive Gynecol. 2005; 12: 302-307
- Complications of laparoscopic surgery: How to avoid them and how to repair them.J Minim Invasive Gynecol. 2006; 13: 352-359
- A randomized comparison of Verres needle and direct trocar insertion for laparoscopy.Surgery. 1993; 177: 259-262
- A modified instrument and method for laparoscopy.Am J Obstet Gynecol. 1971; 110: 886-887
- Direct laparoscope trocar insertion without prior pneumoperitoneum.J Reprod Med. 1978; 21: 45-47
- An evaluation of four tests used to ascertain Veres needle placement at closed laparoscopy.J Minim Invasive Gynecol. 2005; 12: 153-158
- Laparoscopic entry techniques.Cochrane Database Syst Rev. 2008; 16: CD006583
- Direct trocar Insertion vs. Verres Needle use for laparoscopic sterilization.J Reprod Med. 1990; 35: 891-894
- Laparoscopic entry techniques (review).Cochrane Libr. 2010;
- Complications of laparoscopic surgery.Surg Clin North Am. 1993; 73: 265-288
- Endoscopic cholecystectomy. An analysis of complications.Gynaecol Endosc. 1991; 126: 1192-1198
Preventing entry related gynaecological laparoscopic injuries. RCOG Green-top Guideline No. 49: May 2008. http://www.rcog.org.uk/files/rcog-corp/uploaded files/GT49PreventingLaparoscopicInjury2008.pdf.
- Laparoscopic entry techniques: clinical guideline, national survey and medicolegal ramifications.Surg Endosc. 2008; 22: 2686-2697
- Systematic review of the safety and effectiveness of methods used to establish pneumoperitoneum in laparoscopic surgery.Br J Surg. 2003; 90: 668-679
- The safety and efficacy of direct trocar insertion with elevation of the rectus sheath instead of the skin for pneumoperitoneum.Surg Laparosc Endosc Percutan Tech. 2005; 15: 80-81
- Direct trocar versus veress needle entry for laparoscopy: a randomized clinical trial.Gynecol Obstet Invest. 2010; 69: 260-263
- Efficacy of establishment of pneumoperitoneumwith the Veress Needle, Hasson trocar, and modified blunt trocar (TrocDoc): a randomized study.J Laparoendosc Adv Surg Tech A. 2000; 10: 325-330
- Blind versus open approach to laparoscopic cholecystectomy.Surg Laparosc Endosc. 1998; 8: 353-355
Article info
Publication history
Published online: September 27, 2013
Accepted:
September 12,
2013
Received in revised form:
August 12,
2013
Received:
November 9,
2012
Footnotes
☆Clinical Trial ID: NCT01597362.
Identification
Copyright
© 2013 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
