Routine use of open technique in laparoscopic operations.
BACKGROUND
The "blind" insertion of the Veress needle for insufflation of the peritoneal cavity with subsequent closed placement of the first trocar during laparoscopic abdominal procedures can result in severe major vascular and visceral injuries. An open technique was proposed as an alternative method for insufflation in patients with abdominal scars to reduce the possibility of such complications. The aim of this article is to report the results of our experience with the routine use of open technique in laparoscopic surgery.


METHODS
Open technique was routinely used and prospectively evaluated in 330 patients who underwent laparoscopic procedures.


RESULTS
Laparoscopic conversion was necessary in 25 out of 330 cases (7.6 percent): in 20 cases for unclear biliary anatomy during laparoscopic cholecystectomy, and in 5 cases for minor hemorrhage that could not be managed by laparoscopy. In the 305 procedures completed by laparoscopy, 11 patients (3.6 percent) had 13 postoperative complications. These complications were all of minor importance and were always unrelated to trocar insertion; in particular, no major vascular or visceral injuries were observed.


CONCLUSIONS
Routine use of open technique for pneumoperitoneum represents the best prevention of most of the severe trocar-related complications that are potentially avoidable.
Nuzzo
G
G
Department of Geriatric Surgery, Catholic University of the Sacred Heart, School of Medicine, Rome, Italy.
Giuliante
F
F
Tebala
G D
GD
Vellone
M
M
Cavicchioni
C
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D020706:Laparoscopes; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D013536:Suture Techniques; D014172:Transillumination