title: Cameraless peritoneal entry in abdominal laparoscopy.
abstract: OBJECTIVE
  Despite significant advances in laparoscopic instrumentation and techniques, injury to intraabdominal structures remains a potentially serious complication of peritoneal access. Consensus on the best method to obtain peritoneal access is lacking. A safe technique that does not rely on direct visualization of the abdominal layers could shorten the learning curve for surgeons and potentially be adopted by other physicians for a variety of nonsurgical indications for peritoneal entry.
  
  
  METHODS
  A prospective series of 99 consecutive patients who underwent upper-abdominal laparoscopic surgery performed by a single surgeon between January 2009 and June 2010 was reviewed. The method used to obtain peritoneal access was the fluid-based peritoneal entry indication technique (C-PET) with the EndoTIP trocar.
  
  
  RESULTS
  Successful abdominal entry using C-PET was achieved in 90 (90.9%) of the patients; no trocar-related injuries or other injuries associated with peritoneal access occurred. The mean time from incision to confirmed peritoneal access was 21.4 s (range, 12 to 65). Of the 9 cases in which C-PET did not successfully gain entry, 6 occurred during the first 20 surgeries and only 3 in the final 79.
  
  
  CONCLUSIONS
  C-PET is simple, safe, timely, and effective for gaining peritoneal access during laparoscopic abdominal surgeries. In this series, C-PET produced no complications and proved effective across a wide variety of patients, including the obese and those who had had previous surgery. Furthermore, C-PET does not require visual recognition of anatomic layers and potentially could easily be taught to nonsurgeon physicians who perform peritoneal access.
authors.affiliation: Department of Urology, Dalhousie University, Halifax, NS, Canada.
authors.forename: William H
authors.initials: WH
authors.lastname: Carlson
authors.forename: Griffeth
authors.initials: G
authors.lastname: Tully
authors.forename: Amit
authors.initials: A
authors.lastname: Rajguru
authors.forename: Dan R
authors.initials: DR
authors.lastname: Burnett
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Rendon
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004066:Digestive System Diseases / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery*; D011446:Prospective Studies; D055815:Young Adult