title: Primary access-related complications in laparoscopic cholecystectomy via the closed technique: experience of a single surgical team over more than 15 years.
abstract: BACKGROUND
  Laparoscopic cholecystectomy (LC), a common laparoscopic procedure, is a relatively safe invasive procedure, but complications can occur at every step, starting from creation of the pneumoperitoneum. Several studies have investigated procedure-related complications, but the primary access- or trocar-related complications generally are underreported, and their true incidence may be higher than studies show. Major vascular or visceral injury resulting from blind access to the abdominal cavity, although rare, has been reported. Of the two methods for creating pneumoperitoneum, the open access technique is reported to have the lower incidence of these injuries. The authors report their experience with the closed method and show that if performed with proper technique, it can be as rapid and safe as other techniques. However, injuries still happen, and the search for the predisposing factors must be continued.
  
  
  METHODS
  Between January 1992 and December 2007, a retrospective study examined 15,260 cases of LC performed for symptomatic gallstone disease in the authors' institution by a single team of surgeons. The primary access-related injuries in these cases were retrospectively analyzed.
  
  
  RESULTS
  In 15,260 cases of LC, 63 cases of primary access-related complications were identified, for an overall incidence of 0.41%. Major injuries in 11 cases included major vascular and visceral injuries, and minor injuries in 52 cases included omental and subcutaneous emphysema. For the closed method, the findings showed an overall incidence of 0.14% for primary access-related vascular injuries and 0.07% for visceral injuries.
  
  
  CONCLUSIONS
  Primary access-related complications during LC are common and can prove to be fatal if not identified early. The incidence of these injuries with closed methods is no greater than with open methods. No evidence suggests abandonment of the closed-entry method in laparoscopy.
authors.affiliation: Department of Minimal Access Surgery, ILS Multispeciality Clinic, DD-6, Sector-I, Salt Lake City, Kolkata, 700 064, India.
authors.forename: Prakash Kumar
authors.initials: PK
authors.lastname: Sasmal
authors.forename: Om
authors.initials: O
authors.lastname: Tantia
authors.forename: Mayank
authors.initials: M
authors.lastname: Jain
authors.forename: Shashi
authors.initials: S
authors.lastname: Khanna
authors.forename: Bimalendu
authors.initials: B
authors.lastname: Sen
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data*; D002769:Cholelithiasis / Q000175:diagnosis / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D015994:Incidence; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D020706:Laparoscopes / Q000009:adverse effects* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D013525:Surgical Instruments; D015996:Survival Rate; D016896:Treatment Outcome