title: Coming to terms with the fact that the evidence for laparoscopic entry is as good as it gets.
abstract: Entry to the peritoneal cavity for laparoscopic surgery is associated with defined morbidity, with all entry techniques associated with substantial complications. Debate over the safest entry technique has raged over the last 2 decades, and yet, we are no closer to arriving at a scientifically valid conclusion regarding technique superiority. With hundreds of thousands of patients required to perform adequately powered studies, it is unlikely that appropriately powered comparative studies could be undertaken. This review examines the risk of complications related to laparoscopic entry, current statements from examining bodies around the world, and the medicolegal ramifications of laparoscopic entry complications. Because of the numbers required for any complications study, with regard to arriving at an evidence-based decision for laparoscopic entry, we ask: is the current literature perhaps as good as it gets?
authors.affiliation: Royal Hospital for Women, Sydney, Australia and University of New South Wales, Sydney, Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Cuss
authors.affiliation: University of New South Wales, Sydney, Australia.
authors.forename: Mominah
authors.initials: M
authors.lastname: Bhatt
authors.affiliation: Royal Hospital for Women, Sydney, Australia and University of New South Wales, Sydney, Australia. Electronic address: j.abbott@unsw.edu.au.
authors.forename: Jason
authors.initials: J
authors.lastname: Abbott
mesh_terms: D000328:Adult; D019317:Evidence-Based Medicine; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control*; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D010529:Peritoneal Cavity / Q000601:surgery; D017410:Practice Guidelines as Topic
keywords: Abdominal entry; Closed entry; Complications; Gynecology; Hasson entry; Laparoscopy; Open entry; Veress needle