Dataset Information

Laparoscopic entry techniques: Which should you prefer?

ABSTRACT:

Background

Despite a debate spanning two decades, no consensus has been achieved about the safest laparoscopic entry technique.

Objectives

To update the evidence about the safety of the main different laparoscopic entry techniques.

Search strategy

Six electronic databases were searched from inception to February 2021.

Selection criteria

All randomized controlled trials (RCTs) comparing different laparoscopic entry techniques were included.

Data collection and analysis

Entry-related complications and total time for entry were compared among the different methods of entry calculating pooled odds ratios (ORs) and mean differences, with 95% confidence intervals (CIs); P < 0.05 was considered significant.

Main results

In total, 25 RCTs (6950 patients) were included. Complications considered were vascular, visceral and omental injury, failed entry, extraperitoneal insufflation, bleeding and infection at the trocar site bleeding, and incisional hernia. Compared to direct trocar, the OR for Veress needle was significantly higher for omental injury (OR 3.65, P < 0.001), for failed entry (OR 4.19, P < 0.001), and for extraperitoneal insufflation (OR 5.29, P < 0.001). Compared to the open method, the OR for Veress needle was significantly higher for omental injury (OR 4.93, P = 0.001), for failed entry (OR 2.99, P < 0.001), for extraperitoneal insufflation (OR 4.77; P = 0.04), and for incisional hernia. Compared to the open method, the OR for direct trocar was significantly lower for visceral injury (OR 0.17, P = 0.002) and for trocar site infection (OR 0.27, P = 0.001).

Conclusions

The direct trocar method may be preferred over Veress needle and open methods as a laparoscopic entry technique since it appears associated to a lower risk of complications.

SUBMITTER: Raimondo D

PROVIDER: S-EPMC10087714 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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Publications

Laparoscopic entry techniques: Which should you prefer?

Raimondo Diego D Raffone Antonio A Travaglino Antonio A Ferla Stefano S Maletta Manuela M Rovero Giulia G Renzulli Federica F de Laurentiis Umberto U Borghese Giulia G Ambrosio Marco M Salucci Paolo P Casadio Paolo P Mollo Antonio A Seracchioli Renato R

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 20220901 3

<h4>Background</h4>Despite a debate spanning two decades, no consensus has been achieved about the safest laparoscopic entry technique.<h4>Objectives</h4>To update the evidence about the safety of the main different laparoscopic entry techniques.<h4>Search strategy</h4>Six electronic databases were searched from inception to February 2021.<h4>Selection criteria</h4>All randomized controlled trials (RCTs) comparing different laparoscopic entry techniques were included.<h4>Data collection and anal ...[more]

PMID: 35980870

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Project description:ObjectiveTo demonstrate techniques of laparoscopic surgery while all elective procedures are suspended.DesignStepwise demonstration of key skills required when gardening with minimal access techniques.SettingGynecologist residence in self-isolation, Manchester, United Kingdom.InterventionsOwing to the coronavirus disease pandemic, elective operations are currently suspended in the United Kingdom. In addition, there have been concerns regarding the safety of laparoscopic surgery and risk of transmission of the coronavirus disease [1,2]. As a result, laparoscopic surgeons are at risk of skill deterioration, and it is uncertain whether this may have an impact on patient safety when lockdown measures are de-escalated.Combining gardening, one of the major pastimes during the lockdown period, and minimal access surgical skills, this video demonstrates the different ways minimal access surgery may be applied to horticulture.In the first described technique, what the author believes to be hedge bindweed (Calystegia sepium) was excised using a grasper and a tripolar cutting device (Fig. 1). For obvious reasons diathermy is not available within the home environment, but the retractable cutting blade was used to efficiently slice through the stems required for weed removal. The disadvantage of this technique is clearly that the unwanted species is likely to regrow in 12 months.In the second described technique, dandelions (genus Taraxacum) (Fig. 2), which are native to Eurasia and North America, were excised at the flowering stage, thereby effectively preventing asexual reproduction by apomixis. The technique similarly uses the retractable blade of the tripolar cutting device.The third technique demonstrates harvesting of an unknown species using a soil dissection technique. To facilitate complete removal of the plant and to reduce the risk of recurrence, the roots are carefully dissected out using blunt dissection. As with many techniques, patience is of paramount importance.Last, ensuring hydration of plants is crucial to their early stage of development. Laparoscopic watering techniques are usually simplified when an irrigation and suction device is employed. However, within a low-resource setting a slow process of "cup feeding" is required and requires meticulous dexterity (Fig. 3). Unfortunately, during this demonstration a common complication of a loss of instrument occurred, but the subject was luckily successfully hydrated.ConclusionWhile a lockdown remains in place, many gynecologists are not able to maintain their laparoscopic surgical skills. It is important to combine activities of daily living with minimal access training to maintain our physical and mental well-being. More research is clearly needed in the area of minimal access horticulture to expand this new and exciting subspecialty.

Dataset Information

Laparoscopic entry techniques: Which should you prefer?

Background

Objectives

Search strategy

Selection criteria

Data collection and analysis

Main results

Conclusions

Publications

Laparoscopic entry techniques: Which should you prefer?

Similar Datasets

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