Voies d’abord de la cœlioscopie : cœlioscopie ouverte ou cœlioscopie fermée ? Attitude des CHU français

Abstract

Standard technique of insufflation of the pneumoperitoneum includes the use of the Veress needle followed by the blind insertion of the umbilical trocar. To avoid blind trocar insertion, numerous techniques for the creation of the pneumoperitoneum have been reported: openlaparoscopy and microlaparoscopy are the two major alternative methods used in France. The aim of this study was to detennine the incidence of openlaparoscopy in the French departments of Gynecology of the University Hospitals. With this purpose, we send to each chief of the department of Gynecology in a University Hospital a simple questionnaire about the methods used in his division for the creation of pneumoperitoneum. Sixty-three chiefs of department have answered to the questionnaire. Thirteen (21 %) answered they only used conventional technique. Ten (16%) departments perfonned always openlaparoscopy, and 40 University Hospital mostly used conventional technique combined sometimes when the initial procedure of insufflation failed or seems to be too dangerous (Obesity, previous laparotomy... ). Five surgeons used a lateral rather than umbilical insertion for the openlaparoscopy in case of previous laparotomy. Fifteen departments used microlaparoscopy since 1995, and mostly since 1998. We conclude that no simple technique can claim to be overwhelmingly superior. It seems tous dangerous to impose or to condemn any methods. Keeping the choice of the technique, learning security and organizing the survey of our results remain our recommendations for the approaches of abdominal entry for laparoscopy.