Reduction of cannula-related laparoscopic complications using a radially expanding access device

Abstract

Study objective: To determine the safety of a new radially expanding access device compared with complication rates associated with sharp laparoscopic cannulas.

Design: Prospective, multicenter study (Canadian Task Force classification II-1).

Setting: Free-standing and hospital-based ambulatory surgery centers.

Patients: Two hundred twelve women undergoing various laparoscopic procedures and followed over 44 months.

Intervention: Five hundred forty-one radially dilating access devices were used exclusively for laparoscopic abdominal wall access.

Measurements and main results: No major vascular injury, abdominal wall bleeding, intestinal injury, bladder or ureteral injury, liver trauma, or postoperative incisional hernia occurred. One patient developed a postoperative mesenteric hematoma probably caused by a venous injury from the Veress needle. Of the 541 radially expanding access cannulas placed, only 6 (1%) slipped, despite absence of fascial anchoring devices.

Conclusion: Radially dilating abdominal access devices may reduce laparoscopic complications, lessen a surgeon's exposure to liability, and improve patient outcomes while reducing facility costs. (J Am Assoc Gynecol Laparosc 6(1):79-84, 1999)