Surgical Endoscopy

, Volume 22, Issue 12, pp 2686–2697 | Cite as

Laparoscopic entry techniques: clinical guideline, national survey, and medicolegal ramifications

  • Rajesh VarmaEmail author
  • Janesh K. Gupta



This study aimed to establish criteria for safe laparoscopic entry through a systematic literature search and evidence-based medicine appraisal, to determine surgeon preferences for laparoscopic entry in the United Kingdom, and to appraise the medicolegal ramifications of complications arising from laparoscopic entry.


A systematic literature search of MEDLINE and EMBASE (1996–2007) was performed as well as a national surgeon survey by questionnaire (May–December 2006).


Laparoscopic entry criteria involving 10 steps were established based on the systematic literature search and evidence-based critical appraisal. The national survey had 226 respondents, with the majority aware of the Middlesbrough consensus or Royal College of Obstetricians and Gynaecologists [RCOG]-sourced guidance. There was considerable variation in preferred laparoscopic entry techniques. Currently, there is clear judicial guidance on the medicolegal stance toward laparoscopic entry-related complications.


Despite widespread awareness of laparoscopic entry guidelines, there remains considerable variation in the techniques adopted in clinical practice. Unless practice concurs with recommended guidance, women undergoing laparoscopy will be exposed to increased unnecessary operative risk. Laparoscopic entry-related injury in an uncomplicated woman is considered negligent practice according to UK legal case law.


Laparoscopic entry Guidelines Laparoscopy Pneumoperitoneum Artificial Surgical procedures Minimally invasive Intraoperative complications 



We thank Miss Rachel Lacey, Medical Student, University of Liverpool, who helped with analysis of the questionnaire database.


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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of Women’s HealthGuy’s and St. Thomas’ NHS Foundation Trust, St. Thomas’ HospitalLondonUK
  2. 2.Department of Obstetrics and GynaecologyBirmingham Women’s HospitalBirminghamUK

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