Comparison between different entry techniques in performing pneumoperitoneum in laparoscopic surgery


ABSTRACT:Background The main challenge facing the laparoscopic surgery is the primary abdominal access, as it is usually a blind procedure associated with vascular and visceral injuries. It has been proved from studies that 50% of laparoscopic major complications occur prior to the commencement of the surgery. The surgeon must have adequate training and experience in laparoscopic surgery before intending to perform any procedure independently. He should be familiar with the equipment, instrument and energy source he intends to use. Aim of the studyAim of this dissertation is to study the incidence of complications according to different techniques used for inducing pneumoperitoneum in laparoscopic surgery. Patients and methodsProspective and retrospective data was collected for (360) patients underwent laparoscopic surgery from January 2009 to April 2010 in Al-Sader teaching hospital , private hospital in Najaf and Alhussien teaching hospital in Nassyriah , all these patients were operated by different surgeons using different entry techniquesResultThree hundred and sixty patients underwent laparoscopic surgery; 300 of them were female and 60 were male. The operations included in our study were cholecystectomy (254), hydatid cyst of the liver (15), perforated peptic ulcer (2), appendectomy (3), diagnostic laparoscopy for infertility and abdominal pathology (56), undescended testes (8), ovarian cyst (20), achalasia and Nissen fundoplication (1). The early complications recorded in our study are abdominal wall vascular injuries ,visceral injuries ,bradycardia , preperitoneal insufflations .The incidence of laproscopic entry related injuries in gynecological operations was 6.9% .But the incidence of laproscopic entry related injuries in major pelvic operations was 7.8% . ConclusionNo single technique or instrument has been proved to eliminate laparoscopic entry associated injury. Proper evaluation of the patient, supported by good surgical skills and reasonably good knowledge of the technology of the instruments remain to be the cornerstone for safe access and success in minimal access surgery.