Laparoscopic entry techniques

A laparoscope is a medical telescope that is inserted under general anaesthesia through small (0.5 to 1 cm) incisions in or near the umbilicus in order to inspect the pelvis or abdomen. Laparoscopy enables direct visualisation of the pelvic and abdominal organs with the laparoscope so key-hole surgery can be performed as indicated. To perform laparoscopy, gas is inserted into the abdomen. Although usually safe, a small minority of patients experience life-threatening complications, including injuries to the blood vessels (0.9 per 1000 procedures) and the bowel (1.8 per 1000 procedures). These complications often occur at the first step of the procedure when the abdominal wall is perforated using specialised instruments to insert the gas. Different doctors use different specialised instruments and techniques. The update of this review demonstrated a reduction in the incidence of failed entry with the use of an open-entry technique in comparison to closed entry. A reduction in the incidence of failed entry, reduced risk of extraperitoneal insufflation (gas in the layers of the abdominal wall) and reduced omental injury were demonstrated with the use of a direct-entry technique in comparison to Veress Needle entry. This review found no evidence that any single technique or specialised instrument used to enter the abdomen helped to reduce the occurrence of vascular and organ injury. More research is required regarding safety, especially in newer techniques for example single-incision laparoscopic surgery (SILS).