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Should we use visual entry techniques in patients with previous laparotomies?

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Gynecological Surgery

Abstract

Laparoscopic surgery has become the method of choice for treating an ever increasing number of gynaecological disorders that require surgery. However, primary port insertion is a potentially dangerous step especially in patients with previous laparotomies. The aim of this study is to identify whether visual entry technique has any advantage over the closed one in patients with previous laparotomies. This is a retrospective observational case control study of 2541 patients with previous laparotomies who underwent laparoscopic surgery from January 1992 to September 2003 at Vijaya Hospital, Kochi and from October 2003 to October 2015 at Department of Endoscopy, Paul’s Hospital, Kochi, India. The control group comprised of 1261 patients, operated between January 1992 and September 2003 at Vijaya Hospital, Kochi, in whom closed technique of abdominal access for primary port creation was used. The study group comprised of 1280 patients, operated between October 2003 and October 2015 at Department of Endoscopy, Paul’s Hospital, Kochi, in whom visual entry (EndoTIP) was used for primary port creation. Procedures included in both groups were total laparoscopic hysterectomy, laparoscopic myomectomy, laparoscopic ovarian cystectomy, laparoscopic conservative surgery, laparoscopic tubal reanastomosis, laparoscopic sacrocolpopexy, laparoscopic sacrocervicopexy, laparoscopic adhesiolysis and laparoscopic sterilisation. There was no evidence of intestinal or vascular injury during visual entry using a blunt EndoTIP cannula. There were three cases of bowel injury with the closed, blind entry technique using a sharp linear trocar in the control group. The p value (Chi-square test) is 0.04, which is statistically significant. Visual entry, as an approach to abdominal access in patients with previous laparotomies, wherein chances of encountering peritoneal and bowel adhesions are very high, is safer than the closed blind entry technique in preventing bowel injuries.

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Contributions of authors

Dr. P. G Paul, operating surgeon, has contributed in planning and conducting of the research work. Dr. Reena Garg has contributed in planning the concept and design of the study, data collection and analysis and preparation of the manuscript. Dr. Aditya S Khurd has contributed in the data collection, analysis and preparation of the manuscript. Dr. Tanuka Das has contributed in the data collection and analysis. Dr. Manju Thomas and Dr. Radhika KT have contributed in the preparation of the manuscript.

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Authors and Affiliations

  1. Centre for Advanced Endoscopy & Infertility Treatment, Paul’s Hospital, Vattekkattu Road, Kaloor, Kochi, Kerala, 682 017, India

    P. G. Paul, Reena Garg, Aditya S. Khurd, Tanuka Das, Manju Thomas & K. T. Radhika

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  1. P. G. Paul
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  2. Reena Garg
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Correspondence to P. G. Paul.

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The authors declare that they have no conflict of interest. The authors alone are responsible for the content and writing of the paper.

Ethics approval

The study was formally approved by ethical committee of Paul’s Hospital, Kochi, Kerala, India.

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Informed consent was obtained from all individual participants included in the study.

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Paul, P.G., Garg, R., Khurd, A.S. et al. Should we use visual entry techniques in patients with previous laparotomies?. Gynecol Surg 13, 387–393 (2016). https://doi.org/10.1007/s10397-016-0964-2

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  • DOI: https://doi.org/10.1007/s10397-016-0964-2

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