Guideline No. 412: Laparoscopic Entry for Gynaecological Surgery

Abstract

Objective: To evaluate the benefits and risks of laparoscopic surgery and provide clinical direction on entry techniques, technologies, and their associated complications in gynaecological surgery.

Target population: All patients, including pregnant women and women with obesity, undergoing laparoscopic surgery for various gynaecological indications.

Options: The laparoscopic entry techniques and technologies reviewed in formulating this guideline included the closed (Veress needle-pneumoperitoneum-trocar) technique, direct trocar insertion, open (Hasson) technique, visual entry systems, and disposable shielded and radially expanding trocars.

Outcomes: Implementation of this guideline should optimize decision-making in the selection of entry technique for laparoscopic surgery.

Evidence: We searched English-language articles from September 2005 to December 2019 in PubMed/MEDLINE, Embase, Science Direct, Scopus, and Cochrane Library using the following MeSH search terms alone or in combination: laparoscopic entry, laparoscopy access, pneumoperitoneum, Veress needle, open (Hasson), direct trocar, visual entry, shielded trocars, radially expanded trocars, and laparoscopic complications.

Validation methods: The authors rated the quality of evidence and strength of recommendations using the Canadian Task Force on Preventive Health Care approach (Appendix A).

Intended audience: Surgeons performing laparoscopic gynaecological surgery.

Summary statements: RECOMMENDATIONS.

Keywords: Hasson technique; Veress needle; direct trocar insertion; laparoscopic surgery; pneumoperitoneum; visual entry system.