"Semi-open" blunt primary access to the abdominal cavity during laparoscopic surgery: a new technique.

Abstract

Despite major technologic advances in laparoscopic surgery, the creation of the pneumoperitoneum remains a critical step and is associated with a recognized incidence of complications. The aim of this study was to evaluate the safety and feasibility of a new "semi-open" blunt technique for primary cannulation of the abdominal cavity in patients undergoing laparoscopic surgery. Between October 2000 and November 2001, 300 patients underwent laparoscopic surgery under the care of one surgeon. Surgery was elective in 158 patients and urgent/emergent in 142 patients. The semi-open blunt technique for primary cannulation of the peritoneal cavity was applied in 241 (80%) of the patients and was periumbilical in most cases. A closed blunt technique was applied in 48 (16%) of the patients, and the Veress needle was used in 11 (4%) of the patients. The semi-open blunt technique for primary cannulation of the abdominal cavity successfully achieved access in all patients in whom it was attempted. Minor live injuries occurred in two patients (one with the semi-open method and one with the Veress needle). No port site incisional hernias were encountered during a median follow-up of 6 months. The semi-open blunt technique of primary cannulation of the peritoneal cavity achieves rapid, safe, and successful access to the abdomen for laparoscopy. It is associated with minimal periportal gas leakage and port dislodgement and is an alternative method for primary cannulation.