[Open pneumoperitoneum for the sake of Quality Assurance].
The establishment of a pneumoperitoneum for coelioscopy is a maneuver which may have lethal consequences. The open or Hasson technique involves dissection of the abdominal wall layers and insertion of a blunt trocar under direct vision. The conclusions of a recent study comparing "open" and "blind" trocar insertion recommends that the "open" technique be routinely used as a measure of Quality Assurance. A programmed, standardized approach is the only way to prevent undesired complications. Surgeons often plead that the uniqueness of each patient argues against a rigidly standardized technique. But isn't this argument of patient variability just an alibi to avoid adherence to explicit and proven standards? When it comes to guaranteeing patient safety, shouldn't the demonstration that a technique diminishes risk be considered an adequate level of proof if there is no demonstrated benefit to the more dangerous approach? In laparoscopy, where are the proven benefits which would mitigate the undeniable increased risks of "blind" trocar insertion? Initial trocar insertion for laparoscopy by the "open" technique should be standard practice for reasons of safety. The calculus is simple. Given the innumerable laparoscopic surgeries performed every day, there are patients who die daily as a result of "blind" trocar insertion.
Service de Chirurgie Viscérale et Digestive, Hôpital St Eloi, Montpellier. b-millat@chu-montpellier.fr
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Millat
D006801:Humans; D011028:Pneumoperitoneum, Artificial / Q000379:methods* / Q000592:standards*; D011785:Quality Assurance, Health Care