The comparative study of intraperitoneal access by open versus close method to create pneumoperitoneum in laparoscopic surgeries
Keywords:Closed method, Laparoscopic surgery, Open method, Pneumoperitoneum
Background: Laparoscopy is a Latin word; ‘laparo’ means abdomen and ‘scopein’ means to examine, hence it is an art of examination of abdomen and visceral contents. laparoscopic procedure has been revolutionized and come under routine practice by surgical subspecialties because of it has many advantages over conventional laparotomy like small size scar, short hospital stays, less chance of wound infection, minimal postoperative pain, quick recovery after surgery. The aim of the study was to compare the rates and nature of complication during creation of pneumoperitoneum in open and closed laparoscopic procedure.
Methods: This is a single centre, comparative, observational study. Tools of study include, observation, intraoperative and post-operative observation of complications. Nonprobability sampling (purposive sampling) technique was used in this study. Sample size was 44 (in each group). Written and Informed consent has been taken from all patients who were underwent abdominal laparoscopic surgery.
Results: This study represents the comparison between different open and closed methods for creation of pneumoperitoneum in laparoscopic abdominal surgeries. In this study, according to classification of complication at entry level in open method omental injury found in 2 (12%) patients; extra peritoneal insufflations 1 (6%), port site gas leakage 10 (59%), loss of space 1 (6%), entry in wrong plane 3 (17%). In closed method omental injury found in 4 (13%) patients; extra peritoneal insufflations 4 (13%), port site gas leakage 8 (27%) loss of space 5 (17%), entry in wrong plane 7 (23%), abdominal wall haematoma 4 (13%).
Conclusions: Open method is merely safer than closed technique but due to small number of patients took into study as well as study time period is short. Final judgment for the research, multi centric trials in different institutions are required for the initial, crucial, and technically challenging step of newly emerging field of surgery.
Chotai NR, Choksi DB, Damor S, Bhedi A. Intraperitoneal access by closed method (Veress needle) versus open (Hasson’s) method in laparoscopic surgery to create pneumoperitoneum. Int Surg J. 2017;4:2786-90.
Chana GA, Siddiqui AJ, Zafar SN. Open versus closed method of establishing pneumoperitoneum for Laparoscopic Cholecystectomy. Collage of physicians and surgeons pak. J. 2009;19(9):557-60.
Nuzzo G, Giuliante F, Tebala GD, Vellone M, Cavicchioni C. Routine use of open technique in laparoscopic operations. J Am Coll Surg. 1997;184:58-62.
Jansen FW, Kolkman W, Bakkum EA, de Kroon CD, Trimbos-kemper TC, Trimbos JB. Complications of laparoscopy: an injury about closed versus open entry technique. Am J obstet Gynecol. 2004;190:634-8.
Peitgen K, Nimtz K, Hellinger A, Walz MK. Open approach or Veress needle in laparoscopic interventions? Results of a prospective randomized controlled study. Chirurg. 1997;68:910-3.
Taye MK, Fazal SA, Pegu D, Sakia D. Open vs closed laproscopy: Yet an unresolved controversy. J Clin Diagn Res. 2016;10:4-7.
Ballem RV, Rudomanski J. Techniques of pneumoperitoneum. Surg Laparosc Endosc. 1993;3:423.
Catarci M, Carlini M, Gentileschi P, Santoro E. Major and minor injuries during the creation of pneumoperitoneum: A multicenter study on 12,919 cases. Surg Endosc. 2001;15:566-9.
Hasson HM. A modified instrument and method for laparoscopy. Am J Obstet Gynecol. I971;110(6):886-7.
Azevedo OC, Azevedo JL, Sorbello AA, Miguel GP, Wilson Junior JL, Godoy AC. Evaluation of tests performed to confirm the position of the Veress needle for creation of pneumoperitoneum in selected patients: a prospective clinical trial. Acta Cirurgica Brasileira. 2006;21(6):385-91.
Roviaro GC, Varoli F, Saguatti L, Vergani C, Maciocco M, Scarduelli A. Major vascular injuries in laparoscopic surgery. Surgical Endoscopy and Other Interventional Techniques. 2002;16:1192-6.
Peterson HB, Greenspan JR, Ory HW. Death following puncture of the aorta during laparoscopic sterilization. Obstetr Gyneco. 198259(1):133-4.
Vilos GA, Ternamian A, Dempster J, Laberge PY. Clinical practice gynaecology committee. Laparoscopic entry: a review of techniques, technologies, and complications. J Obstet Gynaecol Can. 2007;29(5):433-47.
Nord HJ. Complications of laparoscopy. Endoscopy. 1992;24(8):693-700.
Ballem RV. Laparoscopic cholecystectomy in a community hospital. N J Med. 1993;90(1):41-2.
Merlin TL, Hiller JE, Maddern GJ, Jamieson GG, Brown AR, Kolbe A. Systematic review of the safety and effectiveness of methods used to establish pneumoperitoneum in laparoscopic surgery. J Bri Surg. 2003;90(6):668-79.
Hamid K, Ahmad S. Comparison of the number of attempts in creating pneumoperitoneum for laparoscopic cholecystectomy using direct trocar versus Veress needle insertion. Age (Years). 2021;47:11-01.
Chapron C, Querleu D, Bruhat MA, Madelenat P, Fernandez H, Pierre F et al. Surgical complications of diagnostic and operative gynaecological laparoscopy: a series of 29,966 cases. Human Reproduction (Oxford, England). 1998;13(4):867-72.
Conacher ID, Soomro NA, Rix D. Anaesthesia for laparoscopic urological surgery. Bri J Anaesthesia. 2004;93(6):859-64.
Schäfer M, Krähenbühl L. Effect of laparoscopy on intra-abdominal blood flow. Surgery. 2001;129(4):385-9.
Woodham BL, Cox MR, Eslick GD. Evidence to support the use of laparoscopic over open appendicectomy for obese individuals: a meta-analysis. Surgical Endoscopy. 2012;26:2566-70.
Elbiss HM, Abu-Zidan FM. Bowel injury following gynecological laparoscopic surgery. African Heal Sci. 2017;17:1237-45.
Molloy D, Kaloo PD, Cooper M, Nguyen TV. Laparoscopic entry: a literature review and analysis of techniques and complications of primary port entry. Aust N Zeal J Obstetr Gynaecol. 2002;42:246-54.
Vilos GA, Ternamian A, Dempster J, Laberge PY, Vilos G, Lefebvre G et al. Laparoscopic entry: a review of techniques, technologies, and complications. J Obstetr Gynaecol Canada. 2007;29(5):433-47.