Entry Technique Research Articles

Comparative study of direct trocar entry versus Veress needle entry for laparoscopic surgery

Introduction: Laparoscopy has revolutionised Surgery with its widespread acceptance as predominantly minimally invasive to intraabdominal surgical procedures. Laparoscopy is the art of examining the abdominal cavity and its contents. It requires insertion of a cannula through the abdominal wall, distention of the abdominal cavity with gas or air (pneumoperitoneum), and visualization and examination of the abdomen’s contents with an illuminated telescope. Material and Methods: This is a prospective and observational study conducted in the Department of General Surgery at Prathima Institute of Medical Sciences over a period of 1 year. All the cases who underwent laparoscopic tubal ligation procedure during this time were taken into account. The traditional technique of Veress Needle entry (Group A) and Direct trocar entry (Group B). Inclusion Criteria: Patients which are posted for planned laproscopic surgeries irrespective of age and sex. Exclusion Criteria: Emergency surgeries. ▪ Patients having abdominal scars crossing umbilicus. ▪ Immunocompromised patients ▪ Seropositive patients.Result: In our present study, a total of 90 patients were included in both the groups out of which 21 (23.4%) were males and 69 (76.6%) were females in Group A and in Group B: 19 (21.1%) were males and 71 (78.9%) were females. The mean time taken to create Pneumoperitoneum in case of Veress Needle entry was 4 min 01 sec, of which maximum was 7 min 10 sec and minimum was only 3 min 05 sec. The mean time taken to create Pneumoperitoneum in case of Direct trocar entry was 1 min 43 sec, of which maximum was 3 min 20 sec and minimum was 1 min 15 sec. Complications arising during procedures were identified and recorded. Group A patients 6 patients witnessed omental emphysema was commonest complication followed by 5 patients preperitoneal insufflation while as the most common complication in group B was omental emphysema in 2 patients. Conclusion: Direct Trocar entry is a safe alternative to the Veress needle entry technique for the creation of pneumoperitoneum. One of the main advantages of this technique is the reduced number of the blind insertions required to gain abdominal access. Other benefits are rapid creation of pneumoperitoneum, less gas use and decreased operating time. In laparoscopic surgeries, it is a more reliable and less time-consuming method.

ViFin

Wearable devices, such as smartwatches and head-mounted devices (HMD), demand new input devices for a natural, subtle, and easy-to-use way to input commands and text. In this paper, we propose and investigate ViFin, a new technique for input commands and text entry, which harness finger movement induced vibration to track continuous micro finger-level writing with a commodity smartwatch. Inspired by the recurrent neural aligner and transfer learning, ViFin recognizes continuous finger writing, works across different users, and achieves an accuracy of 90% and 91% for recognizing numbers and letters, respectively. We quantify our approach's accuracy through real-time system experiments in different arm positions, writing speeds, and smartwatch position displacements. Finally, a real-time writing system and two user studies on real-world tasks are implemented and assessed.

Randomized control trial on effectiveness and safety of direct trocar versus Veress needle entry techniques in obese women during diagnostic laparoscopy.

To determine the benefits and safety of direct trocar insertion versus Veress needle technique in obese women undertaking diagnostic laparoscopy procedures. Randomized-controlled trial on 135 obese women undergoing diagnostic laparoscopy and dye test for infertility was conducted. Women were randomly assigned to either direct trocar access (n = 68) or Veress needle access (n = 67) before achieving pneumoperitoneum. The same surgeon executed thelaparoscopictechniques with a single-puncture technique. The primary outcome measures included total length of the procedure and incidence of any complications, while the mean laparoscopic entry time, volume of CO2 required, and total of tries needed to attain successful entry were secondary outcomes. Intention-to-treat principle was applied to analysis. Women in both groups had similar socio-demographic and clinical characteristics and none were lost to follow-up. The overall length of the procedure was significantly lesser in the direct trocar group compared to the Veress needle group (9.9 ± 6.0 vs 16.7 ± 4.7min; p < 0.001). No significant differences occurred in other outcomes including mean entry time, volume of CO2 used, number of attempts for successful entry, and major/minor complications (p > 0.05). Direct trocar technique may be an effective alternative to Veress needle for pneumoperitoneum in obese women for diagnostic laparoscopy. It has a comparable rapid laparoscopic entry time but a significantly lower duration of the procedure and shorter exposure to anesthesia. Both methods are equally effective as there was no significant difference in the complications recorded. A greater sample trial may be essential for more corroborative substantiation. PACTR201510000999192.

Capsular Reconstruction of the Hip Using Modified Kite Technique: A Technical Guide for Efficient Graft Management and Fixation

Preserving capsular integrity has become an important principle of hip preservation surgery given the increasingly recognized deleterious effects of instability in cases of capsular insufficiency. When capsular tissue is deficient, capsular reconstruction may be indicated to restore function of the iliofemoral ligament and improve hip biomechanics. To date, few studies have presented technical guidance on performing arthroscopic capsular reconstruction of the hip. In this Technical Note, we introduce a modified kite technique for arthroscopic entry, control, and fixation of a capsular reconstruction graft. Similar to flying a kite with multiple fly lines, and to the previously described kite technique for hip labral reconstruction, the principles of this method are founded on the belief that control sutures within a pulley system facilitate safe and efficient graft management during capsular reconstruction procedures.

Fast, Easy, and Safe Establishment of Pneumoperitoneum in Laparoscopic Surgery: The Fingertip Technique.

Background and Objectives:There is no consensus on an ideal abdominal entry in laparoscopic surgery; as such, we aimed to assess the feasibility of the fingertip technique for safe entry and the establishment of pneumoperitoneum in transperitoneal laparoscopic surgery.Methods:We prospectively assessed 96 consecutive patients who underwent laparoscopic transperitoneal surgery between December 2018 and September 2019. For all patients, pneumoperitoneum was performed using the fingertip technique, which we recently defined. The duration of time for initial entry, the occurrence of gas leakage, and the complications were evaluated.Results:The median duration of initial entry was 90 (75 – 145) seconds. Pneumoperitoneum was established on the first attempt in all patients. Some events were encountered at the time of implementation of the fingertip technique, such as subcutaneous minor bleeding (5.2%) and gas leakage (4.1%). These events were controlled with cauterization and suturing. There was no visceral or major vascular injury in any patient case.Conclusions:The fingertip technique is a fast, safe, and feasible method for establishing pneumoperitoneum in transperitoneal laparoscopic surgery.

A prospective study of direct trocar entry versus veress needle entry for laparoscopic surgery

Background: The aim of this study was to compare the outcomes of direct trocar entry without prior pneumoperitoneum at umbilical level (DTI) versus veress needle entry for laparoscopic surgeries in terms of injury to abdominal viscera, safety, need for reinsertion of trocar and the time taken from skin incision to the insertion of camera. Methods: The present study was a prospective study conducted at the Department of General Surgery at Dr. M.K. Shah Medical College & Research Centre & Smt S.M.S. Multispeciality Hospital, Ahmedabad, Gujarat, India. (Faimer School Id: F0006702), a tertiary care hospital, from January 2020 till January 2021. Total of 100 cases were included in the study. All the cases who underwent abdominal laparoscopic surgery during this time duration were taken into account. The patients were divided into two groups bases upon the surgical units in which they were admitted as Group A in which traditional technique of veress needle entry was used for access, and Group B in which direct trocar entry without prior pneumoperitoneum was used. These two groups were compared in terms of the demographic profile, duration of procedure, risk of injuries, safety and various complications which were encountered during the procedure. Results: Patients in both the groups had similar demographic characteristics. The mean duration of the procedure was significantly shorter in group B (1.74 ± 0.6min) than in group A (4.06 ± 1.2min). No major complications in both groups were encountered. Minor complications were significantly less in group B than in group A. Conclusion: From our study we conclude with the opinion that direct trocar entry is as safe as prior insufflation of abdomen with the veress needle in a laparoscopic procedure. It is a time saving procedure, reduces the number of blind procedures and eliminates the complications of veress needle entry.

Study of two laparoscopic entry techniques Closed (Veress needle) technique and Open (Hasson’s) technique to evaluate safety, efficacy and their associated complications

Study of two laparoscopic entry techniques Closed (Veress needle) technique and Open (Hasson’s) technique to evaluate safety, efficacy and their associated complications

Guideline No. 412: Laparoscopic Entry for Gynaecological Surgery.

To evaluate the benefits and risks of laparoscopic surgery and provide clinical direction on entry techniques, technologies, and their associated complications in gynaecological surgery. All patients, including pregnant women and women with obesity, undergoing laparoscopic surgery for various gynaecological indications. The laparoscopic entry techniques and technologies reviewed in formulating this guideline included the closed (Veress needle-pneumoperitoneum-trocar) technique, direct trocar insertion, open (Hasson) technique, visual entry systems, and disposable shielded and radially expanding trocars. Implementation of this guideline should optimize decision-making in the selection of entry technique for laparoscopic surgery. We searched English-language articles from September 2005 to December 2019 in PubMed/MEDLINE, Embase, Science Direct, Scopus, and Cochrane Library using the following MeSH search terms alone or in combination: laparoscopic entry, laparoscopy access, pneumoperitoneum, Veress needle, open (Hasson), direct trocar, visual entry, shielded trocars, radially expanded trocars, and laparoscopic complications. The authors rated the quality of evidence and strength of recommendations using the Canadian Task Force on Preventive Health Care approach (Appendix A). Surgeons performing laparoscopic gynaecological surgery. RECOMMENDATIONS.

Presentation of an open entry technique for laparoscopy through a congenital defect in the umbilical fascia

ObjectiveWe present and describe a modification of the Hasson open entry technique to gain access to the abdominal cavity for laparoscopy in which a congenital defect in the umbilical fascia is identified for entry into the peritoneum and insertion of the primary port. MethodsA single centre, prospective, observational, pilot study has been conducted with no change in clinical practice. Data regarding the success of the technique, time to laparoscope insertion, complications and patient risk factors were collected and presented. ResultsThe team enrolled 114 patients that had the St Helier technique attempted for entry in the abdominal cavity. Entry was achieved for all patients. The technique had 82.5 % success rate while this reduced to 65 % in patients with previous laparoscopies. The mean time to insertion of the laparoscope was 220 s, and there was no significant difference in success with variation in BMI. We recorded no minor or significant intra-operative complications. The superficial wound infection rate was 2.6 % with no other postoperative complications identified at 6-week follow-up. ConclusionsThe presented technique is a safe and successful method of laparoscopic entry with a presumed shorter time until laparoscope insertion than other techniques used. The absence of complications could be attributed to the avoidance of sharp dissection of the umbilical fascia. The less invasive nature could reduce risks of hematoma, infection or hernia that are associated with the standard entry techniques used. Formal studies of long-term outcomes are required, as well as evaluating use in emergency and contaminated cases.

LAPROSCOPIC ENTRY: SAFETY AND EFFICACY OF DIRECT TROCAR TECHNIQUE WITHOUT PRIOR PNEUMOPERITONEUM VS VERRES NEEDLE TECHNIQUE IN LAPAROSCOPIC GYNAECOLOGICAL SURGERY IN A TERTIARY CARE HOSPITAL SETTING:A RANDOMIZED CLINICAL TRIAL

The purpose of our study was to compare whether DTI umbilical entry can be a safe and effective alternate to enter abdominal cavity as compared to insertion after prior pneumoperitoneum as in conventionally practiced VN technique in patients undergoing various gynecologic laparoscopic procedures.&#x0D; STUDY DESIGN: &#x0D; Randomized clinical trial.&#x0D; SETTING:&#x0D; Department of OBGYN PGMI/AMC/LGH Lahore, over a period of two years from Feb 2018 to March 2020.&#x0D; SUBJECTS AND METHODS:&#x0D; It was performed on 150 patients admitted for either diagnostic or operative laparoscopic procedures. These patients were randomly allocated to either DTI (n=75) or VN(n=75). Procedure was performed by highly experienced consultant gynecologist trained in laparoscopy&#x0D; OUTCOME MEASURES:&#x0D; &#x0D; Visceral and Vascular injury&#x0D; Time taken for laparoscope entry into abdomen&#x0D; &#x0D; RESULTS:&#x0D; No major complication was observed in both techniques. 1.3% complication rate was noted in DTI technique while 5.3 % of patients suffered minor complications in VN technique. Mean time for laparoscopic entry was less in DTI technique (1.79+- 2.39 min) than in VN technique (3.63+- 0.64 min) p&lt;0.001&#x0D; CONCLUSION&#x0D; DTI technique is a safer one step effective and faster technique for laparoscopic entry in comparison to conventional VN technique with additional advantage of eliminating complications related to VN technique.

Left Mid Abdomen: An Initial Trocar Entry Site (for complex surgical cases)

Study Objective To demonstrate technique and safety of initial trocar entry into the left mid abdominal wall. Design Video. Setting Small Tertiary Academic University Hospital Center. Patients or Participants N/A Interventions Outline anatomical point on abdomen. Show with video how entry can be accomplished in safe manner. Measurements and Main Results N/A Conclusion Left mid abdomen can be utilized as an initial site for trocar entry with the proper knowledge and setup.

Exploration of Practical Information Entry Technique of One-Shot Drum Audio Samples

Exploration of Practical Information Entry Technique of One-Shot Drum Audio Samples

Demonstration of Safe Entry Techniques for Laparoscopy

To demonstrate different techniques, and detail the considerations for obtaining primary laparoscopic access in gynecologic surgery. Video demonstration of the techniques with narrated discussion of each method. The methods for primary entry in laparoscopy vary by location and technique [1,2]. There are inherent risks with any mode of primary entry, and the risks are also specific to each technique [3-6]. The choice for primary entry depends on the patient's anatomy, surgical history, pathology, and surgeon preference [1,2]. This video reviews considerations for choosing the safest entry point and tips for proper entry technique [4,7-10]. The entry sites reviewed include the umbilicus, left upper quadrant, right upper quadrant, and supraumbilical [11]. The entry technique can be either open (Hasson), closed (Veress), or by direct laparoscopic visualization [9,10,12-14]. No single laparoscopic entry technique is superior [3]. The safest and most successful entry method will vary by case characteristics and surgeon training.

The COVID-19 pandemic: implications for the head and neck anesthesiologist

Purpose:As the COVID-19 pandemic has unfolded, there has been growing recognition of risks to the anesthesia and surgical teams that require careful consideration to ensure optimal patient care. Airway management and other head and neck procedures risk exposure to mucosal surfaces, secretions, droplets, and aerosols that may harbor the SARS-CoV-2 virus. This review provides guidance on optimal practice approaches for performing patient evaluation and management of head and neck procedures with the shared goal of providing safe and effective patient care while minimizing the risk of viral transmission.Methods:The scientific literature was evaluated, focusing on strategies to reduce risk to health care workers involved in airway management and head and neck surgery. The search strategy involved curating consensus statements and guidelines relating to COVID-19 or prior coronavirus outbreaks in relation to aerosol-generating procedures (AGPs) and other high-risk procedures, with the search restricted to the scope of head and neck anesthesia. A multidisciplinary team analyzed the findings, using iterative virtual communications through video conference, telephone, email, and shared online documents until consensus was achieved, loosely adapted from the Delphi technique. Items without consensus were so indicated or removed from the manuscript.Results:Health care worker infection and deaths during the COVID-19 pandemic and prior outbreaks mandate robust standards for infection control. Most head and neck anesthesiology procedures generate aerosols, and algorithms may be modified to mitigate risks. Examples include preoxygenation before induction of anesthesia, rapid sequence induction, closing circuits expeditiously, and consideration of apneic technique for surgical entry of airway. Rescue measures are also modified, with supraglottic airways elevated in the difficult airway algorithm to minimize the need for bag mask ventilation. Personal protective equipment for AGPs include fit-tested N95 mask (or purified air positive respirator), gloves, goggles, and gown for patients with known or suspected COVID-19. Meticulous donning and doffing technique, minimizing personnel and room traffic, diligent hand hygiene, and social distancing all can decrease risks. Perioperative management approaches may differ from commonly employed patterns including avoidance of techniques such as jet ventilation, high-flow nasal oxygen and instead utilizing techniques with a closed ventilatory circuit and secured endotracheal tube, minimizing open suctioning, and preventing aerosolization at emergence. Recommendations are made for the following head and neck procedures and considerations: primary airway management; high-flow nasal oxygen delivery; jet ventilation for laryngotracheal surgery; awake intubation; transnasal skull base surgery; tracheostomy; and use of personal protective equipment.COVID-19 testing may facilitate decision making, but it is currently often unavailable and urgency of surgical treatment must be considered.Conclusions:During pandemics, head and neck anesthesia and surgical teams have a duty to not only provide high quality patient care but also to ensure the safety of the health care team. Several specific perioperative approaches are recommended that have some variance from commonly employed practices, focusing on the reduction of AGP to minimize the risk of infection from patients with known or suspected COVID-19 infection.

Clinical Perspective Concerning Abdominal Entry Techniques

Entry into the abdomen during operative laparoscopy is a source of some controversy regarding the safest and most useful method. The objective of this review is to describe, compare, and contrast the most popular entry techniques. Data were collected from the historical starting point until present day from English language journal articles and book chapters. Descriptive accounts dating back to the start of laparoscopy in the 1970s and spanning to present day well-designed randomized controlled trials and Cochrane reviews were compiled to evaluate the evidence for the effectiveness and safety of abdominal entry techniques. The most common sites of entry are the umbilicus and the left upper quadrant. Between the Veress needle, direct trocar insertion, and open entry there is no high-quality evidence to suggest that any of these offers a universal safety advantage. The Veress needle is still the most used among gynecologists and facilitates primary trocar placement. Direct trocar entry under laparoscopic visualization may be underused, is faster, and may result in fewer failed entries. Open (Hasson) entry can be more technically challenging, but may be best for patients with suspected intra-abdominal adhesions. Surgeon comfort is critical in choosing the entry site, method, and equipment. Surgeon familiarity with entry-failure troubleshooting, possible complications, and management is essential because major entry complications are rare in modern laparoscopy but critical because the essential steps of recognition and management can be lifesaving.

REAL TIME EYE TRACKING FOR PASSWORD AUTHENTICATION

The Generality of today’s authentication systems, including password , fingerprint scanners and Personal Identification Number(PIN) entry, are based on one time, static authentication methods which are prone to attacks. Real time eye tracking contributes significantly for Patients who are incapacitated, internet study , gaze based password entry as well as house hold security applications. The use of real time eye tracking and password authentication system has a wider possibility for reliability, but in this case the system must be secure and restrained for Eye Detection and Tracking. For the user’s security and validation (authentication) personal identification numbers are used abroad thereby reducing the chances of being attacked. In static authentication methods , since the password has to be entered physically using PIN’s there are possibilities for tracking the password using shoulder surfing, in order to avoid this spy game of tracking the password , hands off gaze- based PIN entry techniques are used. The smart camera is used to detect the eye position and for Gaze-based PIN Identification thereby doing the data processing. This project is focused on a real time hands off and gaze based PIN entry , detecting the eye position and tracking the eye movement using the smart camera.

Safety of Veress needle for laparoscopic entry in children: Myth or reality?

IntroductionRecent reports suggested that blind laparoscopic entry techniques, including Veress needle (VN), might increase the risks of potentially fatal complications. Materials and methodsAll consecutive patients who underwent laparoscopy in two Pediatric Hospitals with the use of a Veress needle during a 14-year period have been included. In all cases the first trocar was a radially expanding one (STEP). Complications related to the insertion technique are reported as well as those related to the whole laparoscopic technique. ResultsA total of 3463 patients younger than 18 years of age underwent laparoscopy between January 2006 and December 2019. Of these, 205 (5.9%) were younger than 6 months of age at surgery. Two-hundred-eighty-four patients (8.2%) previously underwent abdominal surgery. During first trocar insertion no major or minor vascular injuries occurred. Two patients (0.06%) experienced bowel lesions. Nine (0.26%) experienced failed entry. Fourteen patients (0.4%) experienced postoperative issues related to trocars positioning, namely, 9 omental eviscerations through port site insertion and 5 cases of hemoperitoneum owing to epigastric vessels lesion during operative trocar positioning. No other issues strictly related to laparoscopic entry technique have been recorded during the study period. No specific risk factors predisposing to complications have been identified but the presence of a positive history of previous abdominal procedures proved to be significantly related to a higher occurrence of bowel injury during Veress needle insertion (p = 0.0067). Discussion and conclusionsAlthough with a number of biases and limitations, our study suggests that creation of pneumoperitoneum with VN combined to first trocar entry with STEP technology in children can represent a safe alternative. An exception is represented by patients who underwent previous abdominal surgeries who should be approached with caution, possibly with an open approach. Anyway, given the relatively poor quality of high-quality studies on this regard, we strongly support the implementation of well-designed RCT in children in order to answer this delicate topic. Type of studyRetrospective. Level of evidenceIV

The Effectiveness of Entry Movement Exercise Model in Diving

Entry is one of the techniques in diving that is important in the final completion of the dive. Indonesian diving athletes have weaknesses in this technique, so entry movement exercise is needed to improve the ability of the entry technique. This study aims to determine the effectiveness of the entry movement exercise model in diving. The study population was Indonesian diving athletes with the determination of 20 purposive samples using the true experimental method with one group pre-test and post-test design. The result of this study indicated that the entry movement exercise model is effective to improve the ability of entry techniques in diving.

Comparative Usability Analysis of Selected Data Entry Methods for Web Systems

This paper addresses usability problems of data entry techniques and patterns in web systems and web sites. In order to carry out a comparative analysis of the solutions a dedicated web application was developed as an experimental tool for performing usability testing. The application was designed in the form of a test divided into scenarios and exercises on filling up selected models. Furthermore, the application recorded usability metrics, questionnaires, open and closed questions, as well as users’ personal data. 40 participants, who took part remotely in the experiment, were split into two distinct groups and completed two separate tests that differed in input data and tested solutions. Some measures referring to the effectiveness, efficiency, and user satisfaction were collected. The results were thoroughly analyzed and the recommendations for the usage of particular models were formulated.

Surgical Approaches for Common Gynecologic and Obstetrics Surgeries.

Common obstetrics and gynecology operations have different approaches and techniques and variations in the procedure. We aimed to discuss different approaches and variations in the techniques of the procedures as cystectomy, myomectomy, laparoscopy entry technique, sacrospinous ligament fixation, uretherocele, and rupture uterus.