title: Initial laparoscopic access in postmenopausal women: a preliminary prospective study.
abstract: OBJECTIVE
  Estrogen loss at menopause has a profound influence on skin, with postmenopausal atrophy and loss of tone and elasticity. Because more than 50% of major laparoscopic complications occur during initial entry under the abdominal skin, the efficacy and the safety of two laparoscopic access techniques were compared in postmenopausal women.
  
  
  METHODS
  One hundred eighty-six postmenopausal women underwent laparoscopic surgery for simple ovarian cysts: 89 were assigned to direct optical access (DOA), abdominal entry (group I), and 97 to the classic closed Veress needle approach, pneumoperitoneum, and trocar entry (group II). The following parameters were compared: time needed for entry into the abdomen, occurrence of vascular and/or bowel injury, and blood loss. Results were analyzed using SAS software, considering P value less than 0.05 as significant.
  
  
  RESULTS
  No statistically significant differences were observed in the occurrence of major vascular and/or bowel injury between the two techniques (P > 0.05), whereas time for abdominal entry was significantly reduced in the DOA group, as well as the occurrence of minor vascular injuries (P < 0.05).
  
  
  CONCLUSIONS
  Results of this preliminary comparison on the DOA and the Veress methods, commonly used by gynecologists, suggest that the visual entry system offers a statistical advantage over the closed Veress needle approach, in terms of time saving and limiting minor vascular injuries, thus enabling a safe and fast visually guided entry in postmenopausal women.
authors.affiliation: Department of Obstetrics and Gynaecology, Vito Fazzi Hospital, Lecce, Italy. andreatinelli@gmail.com
authors.forename: Andrea
authors.initials: A
authors.lastname: Tinelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Malvasi
authors.forename: Marcello
authors.initials: M
authors.lastname: Guido
authors.forename: Olav
authors.initials: O
authors.lastname: Istre
authors.forename: Joerg
authors.initials: J
authors.lastname: Keckstein
authors.forename: Liselotte
authors.initials: L
authors.lastname: Mettler
mesh_terms: D000704:Analysis of Variance; D001284:Atrophy; D015992:Body Mass Index; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D010048:Ovarian Cysts / Q000175:diagnosis / Q000601:surgery*; D018579:Patient Selection; D011028:Pneumoperitoneum, Artificial / Q000379:methods; D017698:Postmenopause / Q000502:physiology; D011446:Prospective Studies; D012449:Safety; D012867:Skin / Q000473:pathology*; D013997:Time Factors; D016896:Treatment Outcome