Skip to main content

Surgical Technique of Traditional Laparoscopic Access

  • Chapter
  • First Online:
Laparoscopic Entry

Abstract

The primary aim of any surgical procedure in gynecology is either to repair or eradicate benign or malignant disorders of the female genital tract. Within this, the potential of minimal invasive surgery for operative treatment gynecological diseases has increased dramatically because intraoperative and postoperative complication rates of laparoscopic procedures appear to be equally or even less frequent compared with conventional abdominal techniques [1, 2]. Compared with open surgical procedures, laparoscopic surgery is less painful for the patient, postoperative cosmetic results from a reduction of scar length are more satisfying, and most important, recovery and return to everyday life are more rapid with the laparoscopic approach [1].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Collinet P, Ballester M, Fauconnier A, Deffieux X, Pierre F. Risks associated with laparoscopic entry. J Gynecol Obstet Biol Reprod (Paris). 2010;39(8 Suppl 2):S123–35.

    Article  CAS  Google Scholar 

  2. Garry R. The benefits and problems associated with minimal access surgery. Aust N Z J Obstet Gynaecol. 2002;42:239–44.

    Article  PubMed  Google Scholar 

  3. Chaudhuri T, Mandal K, Mandal D, Mondal J, Bose B, Basu A. Access in laparoscopy: an appraisal. J Indian Med Assoc. 2010;108(10):674–6.

    PubMed  Google Scholar 

  4. Keren D, Rainis T, Stermer E, Lavy A. A nine-year audit of open-access upper gastrointestinal endoscopic procedures: results and experience of a single centre. Can J Gastroenterol. 2011;25(2):83–8.

    PubMed  Google Scholar 

  5. Sasmal PK, Tantia O, Jain M, Khanna S, Sen B. Primary access-related complications in laparoscopic cholecystectomy via the closed technique: experience of a single surgical team over more than 15 years. Surg Endosc. 2009;23(11):2407–15.

    Article  PubMed  Google Scholar 

  6. Neudecker J, Sauerland S, Neugebauer E, Bergamaschi R, Bonier HJ, Cuschieri A, et al. The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery. Surg Endosc. 2002;16(7):1121–43.

    Article  PubMed  CAS  Google Scholar 

  7. Vilos GA. The ABCs of a safer laparoscopic entry. J Minim Invasive Gynecol. 2006;13:249–51.

    Article  PubMed  Google Scholar 

  8. Vilos GA, Ternamian A, Dempster J, Laberge PY, The Society of Obstetricians and Gynaecologists of Canada. Laparoscopic entry: a review of techniques, technologies, and complications. J Obstet Gynaecol Can. 2007;29(5):433–65.

    PubMed  Google Scholar 

  9. Shamiyeh A, Glaser K, Kratochwill H, Hormandinger K, Fellner F, Wayand WU, et al. Lifting of the umbilicus for the installation of pneumoperitoneum with the Veress needle increases the distance to the retroperitoneal and intraperitoneal structures. Surg Endosc. 2009;23:313–7.

    Article  PubMed  Google Scholar 

  10. Palmer R. Safety in laparoscopy. J Reprod Med. 1974;13:1–5.

    PubMed  CAS  Google Scholar 

  11. Agarwala N, Liu CY. Safe entry technique during laparoscopy: left upper quadrant entry using the ninth intercostal space: a review of 918 procedures. J Minim Invasive Gynecol. 2005;12:55–61.

    Article  PubMed  Google Scholar 

  12. Davila F, Tsin DA, Dominguez G, Davila U, Jesús R, Gomez de Arteche A. Transvaginal cholecystectomy without abdominal ports. JSLS. 2009;13(2):213–6.

    PubMed  Google Scholar 

  13. Garry R. Various approaches to laparoscopic hysterectomy. Curr Opin Obstet Gynecol. 1994;6:215–22.

    Article  PubMed  CAS  Google Scholar 

  14. Reich H, Ribeiro SC, Rasmussen C, Rosenberg J, Vidali A. High-pressure trocar insertion technique. JSLS. 1999;3:45–8.

    PubMed  CAS  Google Scholar 

  15. Hasson HM. Open laparoscopy. Biomed Bull. 1984;5:1–6.

    PubMed  CAS  Google Scholar 

  16. Hasson HM, Rotman C, Rana N, Kumari NA. Open laparoscopy: 29-year experience. Obstet Gynecol. 2000;96(5 Pt 1):763–6.

    Article  PubMed  CAS  Google Scholar 

  17. Huang CC, Yang CY, Wu MH, Wang MY, Yeh CC, Lai IR, et al. Gasless laparoscopy-assisted versus open resection of small bowel lesions. J Laparoendosc Adv Surg Tech A. 2010;20(8):699–703.

    Article  PubMed  Google Scholar 

  18. Wu JM, Yang CY, Wang MY, Wu MH, Lin MT. Gasless laparoscopy-assisted versus open resection for gastrointestinal stromal tumors of the upper stomach: preliminary results. J Laparoendosc Adv Surg Tech A. 2010;20(9):725–9.

    Article  PubMed  Google Scholar 

  19. Bonjer HJ, Hazebroek EJ, Kazemier G, Giuffrida MC, Meijer WS, Lange JF. Open versus closed establishment of pneumoperitoneum in laparoscopic surgery. Br J Surg. 1997;84:599–602.

    Article  PubMed  CAS  Google Scholar 

  20. Catarci M, Carlini M, Gentileschi P, Santoro E. Major and minor injuries during the creation of pneumoperitoneum. A multicenter study on 12,919 cases. Surg Endosc. 2001;15:566–9.

    Article  PubMed  CAS  Google Scholar 

  21. Merlin TL, Hiller JE, Maddern GJ, Jamieson GG, Brown AR, Kolbe A. Systematic review of the safety and effectiveness of methods used to establish pneumoperitoneum in laparoscopic surgery. Br J Surg. 2003;90:668–79.

    Article  PubMed  CAS  Google Scholar 

  22. White JV. Consensus on laparoscopic surgery. J Laparoendosc Surg. 1992;2:195.

    PubMed  CAS  Google Scholar 

  23. Agresta F, Mazzarolo G, Ciardo LF, Bedin N. The laparoscopic approach in abdominal emergencies: has the attitude changed? A single-center review of a 15-year experience. Surg Endosc. 2008;22(5):1255–62.

    Article  PubMed  CAS  Google Scholar 

  24. Kyung MS, Choi JS, Lee JH, Jung US, Lee KW. Laparoscopic management of complications in gynecologic laparoscopic surgery: a 5-year experience in a single center. J Minim Invasive Gynecol. 2008;15(6):689–94.

    Article  PubMed  Google Scholar 

  25. Wind J, Cremers JE, van Berge Henegouwen MI, Gouma DJ, Jansen FW, Bemelman WA. Medical liability insurance claims on entry-related complications in laparoscopy. Surg Endosc. 2007;21(11):2094–9.

    Article  PubMed  Google Scholar 

  26. Valtchev KL. Laparoscopic needle introducer. J Am Assoc Gynecol Laparosc. 2001;8(4):579–82.

    Article  PubMed  CAS  Google Scholar 

  27. Ghezzi F, Cromi A, Siesto G, Boni L, Uccella S, Bergamini V, et al. Needlescopic hysterectomy: incorporation of 3-mm instruments in total laparoscopic hysterectomy. Surg Endosc. 2008;22(10):2153–7.

    Article  PubMed  Google Scholar 

  28. Ikeda F, Vanni D, Vasconcelos A, Podgaec S, Abrão MS. Microlaparoscopy vs. conventional laparoscopy for the management of early-stage pelvic endometriosis: a comparison. J Reprod Med. 2005;50(10):771–8.

    PubMed  Google Scholar 

  29. Tai HC, Lai MK, Chueh SC, Chen SC, Hsieh MH, Yu HJ. An alternative access technique under direct vision for preperitoneoscopic pelvic surgery: easier for the beginners. Ann Surg Oncol. 2008;15(9):2589–93.

    Article  PubMed  Google Scholar 

  30. Sabeti N, Tarnoff M, Kim J, Shikora S. Primary midline peritoneal access with optical trocar is safe and effective in morbidly obese patients. Surg Obes Relat Dis. 2009;5(5):610–4.

    Article  PubMed  Google Scholar 

  31. Hajdinjak T, Oakley NE. Use of optical dilating trocar for initial access during extraperitoneal laparoscopic radical prostatectomy. J Endourol. 2007;21(9):1089–92.

    Article  PubMed  Google Scholar 

  32. Pelosi MA, Pelosi 3rd MA. Laparoscopically assisted colpotomy with the Pelosi illuminator and Visiport trocar system. J Reprod Med. 1996;41(8):548–54.

    PubMed  CAS  Google Scholar 

  33. Tinelli A, Malvasi A, Istre O, Keckstein J, Stark M, Mettler L. Abdominal access in gynaecological laparoscopy: a comparison between direct optical and blind closed access by Veress needle. Eur J Obstet Gynecol Reprod Biol. 2010;148(2):191–4.

    Article  PubMed  Google Scholar 

  34. Tinelli A, Malvasi A, Hudelist G, Istre O, Keckstein J. Abdominal access in gynaecologic laparoscopy: a comparison between direct optical and open access. J Laparoendosc Adv Surg Tech A. 2009;19(4):529–33.

    Article  PubMed  Google Scholar 

  35. Tinelli A, Malvasi A, Guido M, Istre O, Keckstein J, Mettler L. Initial laparoscopic access in postmenopausal women: a preliminary prospective study. Menopause. 2009;16(5):966–70.

    Article  PubMed  Google Scholar 

  36. Minervini A, Davenport K, Pefanis G, Keeley Jr FX, Timoney AG. Prospective study comparing the bladeless optical access trocar versus Hasson open trocar for the establishment of pneumoperitoneum in laparoscopic renal procedures. Arch Ital Urol Androl. 2008;80(3):95–8.

    PubMed  Google Scholar 

  37. Rabl C, Palazzo F, Aoki H, Campos GM. Initial laparoscopic access using an optical trocar without pneumoperitoneum is safe and effective in the morbidly obese. Surg Innov. 2008;15(2):126–31.

    Article  PubMed  Google Scholar 

  38. Berch BR, Torquati A, Lutfi RE, Richards WO. Experience with the optical access trocar for safe and rapid entry in the performance of laparoscopic gastric bypass. Surg Endosc. 2006;20(8):1238–41.

    Article  PubMed  Google Scholar 

  39. Brown JA, Canal D, Sundaram CP. Optical-access visual obturator trocar entry into desufflated abdomen during laparoscopy: assessment after 96 cases. J Endourol. 2005;19:853–5.

    Article  PubMed  Google Scholar 

  40. Altun H, Banli O, Karakoyun R, Boyuk A, Okuducu M, Onur E, et al. Direct trocar insertion technique for initial access in morbid obesity surgery: technique and results. Surg Laparosc Endosc Percutan Tech. 2010;20(4):228–30.

    Article  PubMed  Google Scholar 

  41. Günenç MZ, Yesildaglar N, Bingöl B, Onalan G, Tabak S, Gökmen B. 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(2):80–1.

    Article  PubMed  Google Scholar 

  42. Bernante P, Foletto M, Toniato A. Creation of pneumoperitoneum using a bladed optical trocar in morbidly obese patients: technique and results. Obes Surg. 2008;18(8):1043–6.

    Article  PubMed  Google Scholar 

  43. Agresta F, De Simone P, Ciardo LF, Bedin N. Direct trocar insertion vs Veress needle in non obese patients undergoing laparoscopic procedures: a randomized prospective single-center study. Surg Endosc. 2004;18:1778–81.

    Article  PubMed  CAS  Google Scholar 

  44. Ahmad G, Duffy JM, Phillips K, Watson A. Laparoscopic entry techniques. Cochrane Database Syst Rev. 2008;2:CD006583.

    PubMed  Google Scholar 

  45. Perunovic RM, Scepanovic RP, Stevanovic PD, Ceranic MS. Complications during the establishment of laparoscopic pneumoperitoneum. J Laparoendosc Adv Surg Tech A. 2009;19(1):1–6.

    Article  PubMed  Google Scholar 

  46. Kroft J, Aneja A, Tyrwhitt J, Ternamian A. Laparoscopic peritoneal entry preferences among Canadian gynaecologists. J Obstet Gynaecol Can. 2009;31(7):641–8.

    PubMed  Google Scholar 

  47. Pickett SD, Rodewald KJ, Billow MR, Giannios NM, Hurd WW. Avoiding major vessel injury during laparoscopic instrument insertion. Obstet Gynecol Clin North Am. 2010;37(3):387–97.

    Article  PubMed  Google Scholar 

  48. Vilos GA, Vilos AG, Abu-Rafea B, Hollett-Caines J, Nikkhah-Abyaneh Z, Edris F. Three simple steps during closed laparoscopic entry may minimize major injuries. Surg Endosc. 2009;23(4):758–64.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag London Limited

About this chapter

Cite this chapter

Hudelist, G., Keckstein, J. (2012). Surgical Technique of Traditional Laparoscopic Access. In: Tinelli, A. (eds) Laparoscopic Entry. Springer, London. https://doi.org/10.1007/978-0-85729-980-2_2

Download citation

  • DOI: https://doi.org/10.1007/978-0-85729-980-2_2

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-0-85729-979-6

  • Online ISBN: 978-0-85729-980-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics