title: Modified Open Laparoscopy Using a 5-mm Laparoscope.
abstract: BACKGROUND
  In an effort to minimize injuries associated with closed laparoscopic entry, many surgeons use a 10-mm standard open laparoscopy technique. Disadvantages of this open technique are that it requires a larger incision, fascial sutures, and does not always achieve an airtight seal. Although 5-mm laparoscopics with excellent optics are available, little has been written about open techniques using them.
  
  
  METHODS
  We report a modified 5-mm open laparoscopy technique without fascial sutures. The fascia is elevated with small Kocher forceps and incised in the midline. The peritoneum is bluntly perforated with a hemostat-directed cephalad, and a blunt trocar with a sleeve is inserted in this direction. After rotating the sleeve toward the pelvis, a 5-mm laparoscope is placed into the abdomen before insufflation.
  
  
  RESULTS
  We have performed approximately 350 laparoscopies with only one major complication of a perforated transverse colon densely adherent beneath the umbilicus in a woman without previous abdominal surgery. Minor carbon dioxide leakage was uncommon and no wound infections or hernias occurred.
  
  
  CONCLUSIONS
  This 5-mm modified open laparoscopic entry technique minimizes some of the disadvantages associated with conventional open and closed 10-mm laparoscopic techniques while avoiding blind placement of sharp instruments into the peritoneal cavity.
authors: Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina.
authors: Katherine P
authors: KP
authors: Pryor
authors: William W
authors: WW
authors: Hurd
mesh_terms: D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*