Minilaparoscopy to reduce complications from cannula insertion in patients with previous pelvic or abdominal surgery

Abstract

To evaluate the safety and efficacy of minilaparoscopy for visualization and adhesiolysis of intraabdominal adhesions for safe insertion of a primary umbilical cannula in patients who had previous pelvic or abdominal surgery. Prospective, observational study (Canadian Task Force classification II-1). University-affiliated hospital. Twenty women who had previous pelvic or abdominal surgery, excluding tubal ligation and simple appendectomy. Minilaparoscopy was carried for visualization and adhesiolysis at the entry site before insertion of an umbilical cannula. Eleven patients had Pfannenstiel scars and nine had vertical midline scars from previous surgeries (4 total abdominal hysterectomies, 13 adnexal surgery, 7 cesarean sections, 3 ectopic pregnancies, 1 ruptured appendix, 1 unknown bowel surgery). Thirteen women (65%) had had one previous surgery, five (25%) had had two, and two (10%) had had three. Nine patients (45%) had significant adhesions of omentum or intestine that required adhesiolysis. Mean operating time for minilaparoscopy was 5 minutes for 11 women who had no or minimal adhesions that did not interfere with safe insertion of the umbilical cannula and effective use of a 10-mm telescope, and 25 minutes in 9 patients who required adhesiolysis before insertion of the umbilical cannula because of dense adhesions of omentum or intestine at the entry site. No complications with minilaparoscopy occurred. Minilaparoscopy can be performed safely and effectively to reduce serious vascular or visceral injury from insertion of primary cannula in patients who had previous pelvic and/or abdominal surgery. However, conclusions cannot be derived from this study due to the small number of subjects. Further study is necessary in a larger patient population to evaluate efficacy, safety, and advantages of minilaparoscopy over other techniques. (J Am Assoc Gynecol Laparosc 6(1):91-95, 1999)