title: An open access technique to create pneumoperitoneum in laparoscopic surgery.
abstract: BACKGROUND
  An open access technique might reduce severe vascular and visceral injuries. An open access technique through the umbilical cicatrix tube has been developed as a routine method with the goal to be easy, safe and used by all surgeons in patients without a previous midline incision.
  
  
  OBJECTIVE
  To evaluate the open technique in a prospective study in 100 consecutive laparoscopic operations regarding time for entrance, surgeons experience and BMI of the patients.
  
  
  METHODS
  A midline incision from the linea alba up into the inverted umbilicus was performed in the cicatrix tube and the peritoneum was penetrated allowing air to flow into the abdominal cavity followed by a blunt trocar insertion.
  
  
  RESULTS
  Time for access was median 93 seconds. Entrance time in patients with BMI >30 (n=18) was 100 sec and with BMI <30 it was 90 sec (p = 0.71). The median time for consultants was 88 sec and for residents 120 sec (p = 0.003). No gas leakage was seen. Prolonged time for access was seen in three patients; two equipment failures and one obese patent.
  
  
  CONCLUSIONS
  The open access technique is applicable in all patients without a former midline incision. It is fast, easy to learn with very few associated problems.
authors.affiliation: Department of Surgery, University Hospital of Malmö, Malmö, Sweden. ann-cathrin.moberg@skane.se
authors.forename: A C
authors.initials: AC
authors.lastname: Moberg
authors.forename: U
authors.initials: U
authors.lastname: Petersson
authors.forename: A
authors.initials: A
authors.lastname: Montgomery
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001064:Appendicitis / Q000150:complications / Q000601:surgery*; D015992:Body Mass Index; D002648:Child; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005705:Gallbladder Diseases / Q000150:complications / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome