Advertisement

Establishing Pneumoperitoneum: What Is the Safest Technique for Pneumoperitoneum?

  • Gian Luca BaiocchiEmail author
  • Daniela Prando
  • Davide Piccolo
  • Francesco Brandara
  • Luigi Ciccoritti
  • Federico Gheza
  • Ferdinando Agresta
Chapter
  • 1.5k Downloads

Abstract

Since it represents the first step in any laparoscopic procedure, the technique of pneumoperitoneum establishment and optical trocar insertion has long been a subject for study and debate. The main three techniques available are the open laparoscopy (OL), the Veress needle laparoscopy (VN), and the direct trocar insertion (DTI) technique. Several major (vascular and visceral injury, gas embolism, and failed entry) and minor (extraperitoneal insufflation, trocar site bleeding, infection, and hernia) complications may occur. Many retrospective studies, 32 RCTs, 6 systematic reviews, and 2 Cochrane reviews have addressed this topic. However, owing to some methodological limitations (the main of which is the limited samples as compared to the very low complications rate), a significant difference in major complications has not been clearly demonstrated, although it appears reasonable that OL and DTI with optical trocar would allow for a lower complication rate and above all for a quicker recognition of the eventual complication. From the available data, OL and DTI have a significantly lower rate of failed entry and extraperitoneal gas insufflation, while DTI is the faster technique. In this chapter, a comprehensive review of the literature on this topic is presented, together with an organic revision of access techniques and their complications.

Keywords

Veress Needle Visceral Injury Open Laparoscopy Optical Trocar Visceral Lesion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Hasson HM (1971) A modified instrument and method for laparoscopy. Am J Obstet Gynecol 110:886–887PubMedGoogle Scholar
  2. 2.
    Hanney RM, Carmalt HL, Merrett N, Tait N (1999) Use of the Hasson cannula producing major vascular injury at laparoscopy. Surg Endosc 13:1238–1240PubMedCrossRefGoogle Scholar
  3. 3.
    Sadeghi-Nejad H, Kavoussi LR, Peters CA (1994) Bowel injury in open technique laparoscopic cannula placement. Urology 43(4):559–560PubMedCrossRefGoogle Scholar
  4. 4.
    Hasson HM, Rotman C, Rana N, Kumari NA (2000) Open laparoscopy: 29-year experience. Obstet Gynecol 96(5 Pt 1):763–766PubMedCrossRefGoogle Scholar
  5. 5.
    Campos L, Espinosa M (1991) A modified laparoscopic entry technique using a finger and rubber catheter. J Laparoendosc Surg 1:179–182PubMedCrossRefGoogle Scholar
  6. 6.
    Liu HF, Chen X, Liu Y (2009) A multi-center study of a modified open trocar first-puncture approach in 17,350 patients for laparoscopic entry. Chin Med J (Engl) 122:2733–2736Google Scholar
  7. 7.
    Veress J (1938) Neues instrument zur Ausfuhrung von Brust oder Bauchpunktionen. Dtsch Med Wochensch 41:1480–1481CrossRefGoogle Scholar
  8. 8.
    RCOG (2008) Laparoscopic injuries (Green-Top 49). Royal College of Obstetrics and Gynaecology. London NW1 4RG, UKGoogle Scholar
  9. 9.
    Munro MG (2002) Laparoscopic access: complications, technologies, and techniques. Curr Opin Obstet Gynecol 14(4):365–374, ReviewPubMedCrossRefGoogle Scholar
  10. 10.
    Mintz M (1977) Risks and prophylaxis in laparoscopy: a survey of 100 000 cases. J Reprod Med 18:269–272PubMedGoogle Scholar
  11. 11.
    Ternamian AM, Deitel M (1999) Endoscopic threaded imaging port (EndoTIP) for laparoscopy: experience with different body weights. Obes Surg 9:44–47PubMedCrossRefGoogle Scholar
  12. 12.
    Woolcott R (1997) The safety of laparoscopy performed by direct trocar insertion and carbon dioxide insufflation under vision. Aust N Z J Obstet Gynaecol 37:216–219PubMedCrossRefGoogle Scholar
  13. 13.
    Agresta F, Mazzarolo G, Bedin N (2012) Direct trocar insertion for laparoscopy. JSLS 16(2):255–259PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Ahmad G, O’Flynn H, Duffy JMN, Phillips K, Watson A (2012) Laparoscopic entry techniques. Cochrane Database of Syst Rev (2):CD006583. doi: 10.1002/14651858.CD006583
  15. 15.
    Middlesbrough Consensus (1999) A consensus document concerning laparoscopic entry techniques. Gynaecol Endosc 8:403–406CrossRefGoogle Scholar
  16. 16.
    Bhoyrul S, Vierra MA, Nezhat CR et al (2001) Trocar injuries in laparoscopic surgery. J Am Coll Surg 192:677–683PubMedCrossRefGoogle Scholar
  17. 17.
    Champault G, Cazacu F, Taffinder N (1996) Serious trocar accidents in laparoscopic surgery: a French survey of 103,852 operations. Surg Laparosc Endosc 6:367–370PubMedCrossRefGoogle Scholar
  18. 18.
    Geers J, Holden C (1996) Major vascular injury as a complication of laparoscopic surgery: a report of three cases and review of the literature. Am Surg 62:377–379PubMedGoogle Scholar
  19. 19.
    Schafer M, Lauper M, Krahenbuhl L (2001) Trocar and Veress needle injuries during laparoscopy. Surg Endosc 15:275–280PubMedCrossRefGoogle Scholar
  20. 20.
    Lal P, Singh L, Agarwal PN, Kant R (2004) Open port placement of the first laparoscopic port: a safe technique. JSLS 8(4):364–366PubMedCentralPubMedGoogle Scholar
  21. 21.
    Lal P, Vindal A, Sharma R, Chander J, Ramteke VK (2012) Safety of open technique for first-trocar placement in laparoscopic surgery: a series of 6,000 cases. Surg Endosc 26(1):182–188. doi: 10.1007/s00464-011-1852-5 PubMedCrossRefGoogle Scholar
  22. 22.
    Ballem RV, Rudomanski J (1993) Techniques of pneumoperitoneum. Surg Laparosc Endosc 3:42–43PubMedGoogle Scholar
  23. 23.
    Fitzgibbons RJ, Schmid S, Santoscoy R, Tyndall S, Hinder R, Filipi CJ et al (1991) Open laparoscopy for laparoscopic cholecystectomy. Surg Laparosc Endosc 1:216–222PubMedCrossRefGoogle Scholar
  24. 24.
    Akbar M, Khan IA, Naveed D, Khattak I, Zafar A, Wazir MS et al (2008) Comparison of closed and open methods of pneumoperitoneum in laparoscopic cholecystectomy. J Ayub Med Coll Abbottabad 20:85–89PubMedGoogle Scholar
  25. 25.
    Bemelman WA, Dunker MS, Busch ORC, Den Boer KT, De Wit LTH, Gouma DJ (2000) Efficacy of establishment of pneumoperitoneum with the Veress Needle, Hasson trocar, and modified blunt trocar (TrocDoc): a randomized study. J Laparoendosc Adv Surg Tech A 10(6):325–330PubMedCrossRefGoogle Scholar
  26. 26.
    Cogliandolo A, Manganaro T, Saitta FP, Micali B (1998) Blind versus open approach to laparoscopic cholecystectomy. Surg Laparosc Endosc 8(5):353–355PubMedCrossRefGoogle Scholar
  27. 27.
    Borgatta L, Gruss L, Barad D, Kaali SG (1990) Direct trocar Insertion vs. Veress Needle use for laparoscopic sterilization. J Reprod Med 35(9):891–894PubMedGoogle Scholar
  28. 28.
    Saunders CJ, Battistella FD, Whetzel TP, Stokes RB (1998) Percutaneous diagnostic peritoneal lavage using a Veress needle versus an open technique: a prospective randomized trial. J Trauma 44:883–888PubMedCrossRefGoogle Scholar
  29. 29.
    Minervini A, Davenport K, Pefanis G, Keeley FK Jr, Timoney AG (2008) Prospective study comparing the bladeless optical access versus hasson open trocar for the establishment of pneumoperitoneum in laparoscopic renal procedures. Arch Ital Urol Androl 80(3):95–98PubMedGoogle Scholar
  30. 30.
    Agresta F, DeSimone P, Ciardo LF, Bedin N (2004) Direct trocar insertion versus Veress needle in non obese patients undergoing laparoscopic procedures. Surg Endosc 18:1778–1781PubMedCrossRefGoogle Scholar
  31. 31.
    Byron JW, Markenson G, Miyazawa K (1993) A randomized comparison of Veress needle and direct trocar insertion for laparoscopy. Surgery 177:259–262Google Scholar
  32. 32.
    Zakherah MS (2010) Direct trocar versus veress needle entry for laparoscopy: a randomized clinical trial. Gynecol Obstet Invest 69:260–263PubMedCrossRefGoogle Scholar
  33. 33.
    Prieto-Díaz-Chávez E, Medina-Chávez JL, González-Ojeda A, Anaya-Prado R, Trujillo-Hernández B, Vásquez C (2006) Direct trocar insertion without pneumoperitoneum and the Veress needle in laparoscopic cholecystectomy : a comparative study. Acta Chir Belg 106(5):541–544PubMedGoogle Scholar
  34. 34.
    Tinelli A, Malvasi A, Istre O, Keckstein J, Stark M, Mettler L (2010) Abdominal access in gynaecological laparoscopy: a comparison between direct optical and blind closed access by Veress needle. Eur J Obstet Gynecol Reprod Biol 148:191–194PubMedCrossRefGoogle Scholar
  35. 35.
    Bisgaard T, Jakobsen HL, Jacobsen B, Olsen SD, Rosenberg J (2007) Randomized clinical trial comparing radially expanding trocars with conventional cutting trocars for the effects on pain after laparoscopic cholecystectomy. Surg Endosc 21:2012–2016PubMedCrossRefGoogle Scholar
  36. 36.
    Briel JW, Plaisier PW, Meijer WS, Lange JF (2000) Is it necessary to lift the abdominal wall when preparing a pneumoperitoneum? Surg Endosc 14:862–864PubMedCrossRefGoogle Scholar
  37. 37.
    Kitano S, Iso Y, Moriyama M, Tomikawa M, Sugimachi K (1993) A prospective randomized trial comparing pneumoperitoneum and U-shaped retractor elevation for laparoscopic cholecystectomy. Surg Endosc 7:311–314PubMedCrossRefGoogle Scholar
  38. 38.
    Ostrzenski A (1999) Randomized, prospective, single-blind trial of a new parallel technique of Veress pneumoperitoneum needle insertion versus the conventional closed method. Fertil Steril 71(3):578–581PubMedCrossRefGoogle Scholar
  39. 39.
    Venkatesh R, Sundaram CP, Figenshau RS, Yan Y, Andriole GL, Clayman RV, Landman J (2007) Prospective randomized comparison of cutting and dilating disposable trocars for access during laparoscopic renal surgery. JSLS 11:198–203PubMedCentralPubMedGoogle Scholar
  40. 40.
    Bonjer HJ, Hazebrook EJ, Kazemier MC, Giuffrida MC, Meijer WS, Lange JF (1997) Open versus closed establishment of pneumoperitoneum in laparoscopic surgery. Br J Surg 84:599–602PubMedCrossRefGoogle Scholar
  41. 41.
    Molloy D, Kaloo PD, Nguyen TV, Cooper M (2002) Laparoscopic entry: a literature review and analysis of techniques and complications of primary port entry. Aust N Z J Obstet Gynaecol 42(3):246–255PubMedCrossRefGoogle Scholar
  42. 42.
    Merlin TL, Hiller JE, Maddern GJ, Jamieson GG, Brown AR, Kolbe A (2003) Systematic review of the safety and effectiveness of methods used to establish pneumoperitoneum in laparoscopic surgery. Br J Surg 90:668–679PubMedCrossRefGoogle Scholar
  43. 43.
    Larobina M, Nottle P (2005) Complete evidence regarding major vascular injuries during laparoscopic access. Surg Laparosc Endosc Percutan Tech 15(3):119–123PubMedCrossRefGoogle Scholar
  44. 44.
    Azevedo JL, Azevedo OC, Miyahira SA, Miguel GP, Becker OM Jr, Hypo′ lito OH, Machado AC, Cardia W, Yamaguchi GA, Godinho L, Freire D, Almeida CE, Moreira CH, Freire DF, Opilka M, Starzewski J, Lorenc Z, Tarnowski A, Zawada Z (2009) Injuries caused by Veress needle insertion for creation of pneumoperitoneum: a systematic literature review. Surg Endosc 23:1428–1432PubMedCrossRefGoogle Scholar
  45. 45.
    Opilka M, Starzewski J, Lorenc Z, Tarnowski A, Zawada Z (2009) Open versus closed laparoscopy entry–which are the evidences? Hepatogastroenterology 56:75–79PubMedGoogle Scholar
  46. 46.
    Ahmad G, Duffy JMN, Phillips K, Watson A (2008) Laparoscopic entry techniques. Cochrane Database Syst Rev. doi: 10.1002/14651858
  47. 47.
    Ahmad G, Duffy JMN, Watson AJS (2007) Laparoscopic entry techniques and complications. Int J Gynaecol Obstet 99:1CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Gian Luca Baiocchi
    • 1
    Email author
  • Daniela Prando
    • 2
  • Davide Piccolo
    • 3
  • Francesco Brandara
    • 4
  • Luigi Ciccoritti
    • 4
  • Federico Gheza
    • 1
  • Ferdinando Agresta
    • 2
  1. 1.Department of Clinical and Experimental SciencesSurgical Clinic, University of BresciaBresciaItaly
  2. 2.Department of General SurgeryULSS19 del Veneto AdriaAdriaItaly
  3. 3.Department of General SurgeryULSS3 del Veneto, Bassano del GrappaBassano del GrappaItaly
  4. 4.Department of General SurgerySan Bassiano HospitalBassano del GrappaItaly

Personalised recommendations