Laparoscopy entry in patients with previous abdominal and pelvic surgery

Andrea Tinelli, Antonio Malvasi, Marcello Guido, Daniel Alberto Tsin, Gernot Hudelist, Michael Stark, Liselotte Mettler

Research output: Contribution to journalReview articlepeer-review

30 Scopus citations

Abstract

Background: The background of this investigation is based on a common surgical problem: The access in laparoscopic surgery is more difficult in women with previous abdominopelvic surgery, since adhesions and viscera could be close to the point of trocar insertion. Purpose: The authors analyzed the safety and the efficacy of a modified direct optical entry (DOE) method versus the Hasson's method by open laparoscopy (OL) in women with previous abdominopelvic surgery in a preliminary prospective case-control study. Materials and methods: A total of 168 women underwent laparoscopic surgery in university-affiliated hospitals: 86 were assigned to abdominal DOE (group A) and 82 to OL (group B). The main outcome measures were statistically compared: time required for entry into abdomen, blood loss, and occurrence of vascular and/or bowel injury. All patients had an intraperitoneal view of the primary port site during surgical procedure. Results: Statistical differences, in favor of the DOE group (P <.01), were found in duration of entry and blood loss. The vascular and bowel injuries in OL versus DOE were not statistically different. Conclusions: Obtaining access to the peritoneal cavity in laparoscopic surgery is more difficult in patients with previous abdominopelvic surgery, since it can become a difficult, time-consuming, and occasionally hazardous procedure. The study results suggest that DOE is advantageous when compared with OL in terms of saving time enabling a safe and expeditious visually guided entry for laparoscopy.

Original languageEnglish
Pages (from-to)201-205
Number of pages5
JournalSurgical Innovation
Volume18
Issue number3
DOIs
StatePublished - Sep 2011

Keywords

  • Hasson's method
  • Veress needle
  • adhesions
  • blind closed access
  • complications
  • direct optical access
  • laparoscopic entry
  • open laparoscopy
  • previous surgery

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