No. 193-Laparoscopic Entry: A Review of Techniques, Technologies, and Complications

Abstract

Objective: To provide clinical direction, based on the best evidence available, on laparoscopic entry techniques and technologies and their associated complications.

Options: The laparoscopic entry techniques and technologies reviewed in formulating this guideline include the classic pneumoperitoneum (Veress/trocar), the open (Hasson), the direct trocar insertion, the use of disposable shielded trocars, radially expanding trocars, and visual entry systems.

Outcomes: Implementation of this guideline should optimize the decision-making process in choosing a particular technique to enter the abdomen during laparoscopy.

Evidence: English-language articles from Medline, PubMed, and the Cochrane Database published before the end of September 2005 were searched, using the key words laparoscopic entry, laparoscopy access, pneumoperitoneum, Veress needle, open (Hasson), direct trocar, visual entry, shielded trocars, radially expanded trocars, and laparoscopic complications.

Values: The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on the Periodic Health Examination. RECOMMENDATIONS AND SUMMARY STATEMENT.

Keywords: Hasson technique; Laparoscopy; Veress needle; entry; pneumoperitoneun; visual entry system.