A Safe Quick Technique for Placement of the First Access Port for Creation of Pneumoperitoneum

Abstract

Closed and open techniques for creation of pneumoperitoneum are being used simultaneously with varying frequencies. Some studies analyzing slight modifications to both approaches have been published and others are under way. We conducted this study to eliminate some of the disadvantages of the open technique, an already proven safer technique. In a total of 1250 consecutive patients, who underwent various laparoscopic procedures, a modified open technique was used. This technique involves identification and incision of a point at a junction of the umbilical stalk and linea alba infraumbilically. With this technique, penetration of a blunt trocar was possible under direct vision with minimal and controlled axial force. Time needed to induce pneumoperitoneum, intraoperative (vascular and other organ injury) and postoperative complications were recorded, and data were analyzed. Intraabdominal access was successfully achieved in all cases without any vascular or solid organ injury except in 3 (0.24%) cases. In these 3 cases, the procedure failed due to severe adhesions, because of previous abdominal surgeries. Mean time taken to induce pneumoperitoneum was 4.0 minutes (range, 2 to 9.5), while time required to close the first access port was 4.5 minutes (range, 3 to 8). Enterotomy occurred in 2 (0.16%) cases, while a postoperative port-site hernia occurred in 2 (0.16%) cases. Port-site infection occurred in 6 (0.48%) cases, and port-site hematoma in 4 (0.32%) cases. Gas spillage was recorded in only 6 (0.48%) cases. We recommend a modified open technique as the technique of choice in all cases requiring laparoscopic surgery in general and developing countries in particular where intraabdominal adhesions are not uncommon.