Hasson Cannula Research Articles

Direct trocar insertion without the pneumoperitoneum in laparoscopic surgery - Is this a safe technique?

Introduction The classical closed method using the Veress needle and the open trocar placement technique with the Hasson cannula are commonly used to establish the pneumoperitoneum required for laparoscopic procedures. A less described and practiced technique is direct trocar insertion [DTI]. Those who are unfamiliar with DTI as an alternative procedure may be under the impression that it is hazardous.

Laparoscopic Debridement of Recurrent Pancreatic Abscesses in the Hostile Abdomen

Recurrent necrotizing pancreatitis in the frozen or hostile abdomen remains a challenge. Percutaneous drainage is useful in these cases but often fails if there is significant pancreatic necrosis. We describe a technique for laparoscopic drainage of necrotic pancreas. The preexisting percutaneous drainage tract was sequentially dilated and a working thoracoscope was placed via a Hasson cannula. A pulsatile irrigation system was used to open the cavity for visualization and to wash away obvious necrotic debris. Working sequentially using the irrigation jet flow for debridement and visualization, we opened the entire tract and debrided a majority of the necrotic tissue. A large drainage tube was placed to allow the egress of any residual infection. Three patients to date have been treated with the above technique with no intraoperative complications. All three patients did well initially postoperatively and had adequate drainage. One patient developed a delayed pancreatic pseudocyst. Laparoscopic debridement via percutaneous drainage tract is a useful technique in the hostile abdomen.

Complete Evidence Regarding Major Vascular Injuries During Laparoscopic Access

Recent reports by the Australian Safety and Efficacy Register for New interventions and Procedures (ASERNIP-S) and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) concluded that insufficient evidence is available to assess the safety of the open versus closed laparoscopy in regard to major vascular and visceral injuries. The aim of this study was to assess the relative safety of open and closed laparoscopy with respect to rates of major vascular and visceral injuries. A combined prospective/retrospective review of a single-surgeon series of 5900 open laparoscopies was performed. A meta-analysis of all reported series of open and closed laparoscopy was conducted using PubMed and MEDLINE search engines to compare major vascular and visceral injury rates. Medicolegal and manufacturer device reports were also reviewed. The case series of 5900 open laparoscopies reported a single visceral injury and no major vascular injuries. The meta-analysis revealed 336 major vascular injuries in 760,890 closed laparoscopies, a mean rate of 0.044%, 1 injury per 2272 cases, compared with 0 injuries in 22,465 open laparoscopies (P = 0.003). Visceral injuries occurred more frequently, 515 injuries in 760,890 closed laparoscopies (mean rate, 0.07) and 11 injuries in 22,465 open laparoscopies (mean rate, 0.05; P = 0.18). Medicolegal and device reports revealed a further 647 major vascular injuries and 500 major visceral injuries. In contrast to the conclusion formed by the RANZCOG and ASERNIP-S, the available evidence shows that open laparoscopy eliminates the risk of major vascular injury and reduces the rate of major visceral injuries. Open laparoscopy using the Hasson cannula should be the preferred method of peritoneal access.

A safe technique for the insertion of the Hasson cannula.

Most techniques of Hasson cannula insertion still involve a significant risk of visceral or vascular damage. This is true even for the modified open techniques of cannulation. A technique of sequential clipping and elevation of abdominal wall layers is described, which permits safer Hasson cannulation at the umbilicus or at other sites on the abdomen even in the presence of underlying adhesions. Eight hundred and seventy-six patients underwent laparoscopic cholecystectomy using this technique of Hasson cannulation. Forty-two of these patients had the cannula placed at other sites other than the umbilicus because of previous surgery and suspected adhesions. Using this technique there were no major complications. Specifically, this technique did not incur any cases of visceral or vascular damage. The technique of sequential clipping and elevation of all layers of the abdominal wall during the insertion of the Hasson cannula allows for safer entry into the peritoneal cavity.

Laparoscopic Management of Page Kidney

A 15-year-old white male was found to have significant hypertension on an annual athletic physical examination conducted elsewhere. Severe hypertension was documented on several occasions, with systolic blood pressure in the 160 to 170 mm. Hg range. The patient was initially treated with oral antihypertensives unsuccessfully. Extensive workup included abdominal computerized tomography (CT), which revealed a large right subcapsular renal fluid collection with parenchymal compression (fig. 1). The patient underwent percutaneous drainage of the fluid collection, with temporary resolution of the hypertension for approximately 1 month. However, the hypertension returned, and followup CT demonstrated re-accumulation of the subcapsular renal fluid, prompting referral to our institution. Preoperative imaging consisted of renal ultrasound and captopril mercaptoacetyltriglycine renal scan. The sonogram confirmed an 11.4 5.2 3.2 cm. subcapsular anechoic mass along the right kidney consistent with a fluid collection with compression of the renal parenchyma. In addition, a linear area consistent with renal parenchymal scar from a probable previous laceration was diagnosed. The nuclear medicine scan showed slight delay and decreased perfusion of the right kidney. Laboratory studies were unremarkable except for increased peripheral renin activity. Retroperitoneoscopy using a Hasson cannula approach with balloon dilation was performed. The densely involved fibrotic external renal capsule was excised and the subcapsular fluid collection was drained (fig. 2). In addition, the fibrotic reaction compressing the normal parenchyma was incised to relieve any chronic compressive component. An argon beam laser was used to eradicate residual fibrotic scar and maintain hemostasis. Operative time was 240 minutes, blood loss was minimal and hospital stay was 43 hours. Immediately following the procedure, the patient’s blood pressure decreased to the normal range for his age. He remained normotensive off any medication during 10 months of followup. Followup ultrasound revealed a normal appearing appropriate sized kidney.

The umbilicus in laparoscopic surgery.

This study examines the factors related to infection and incisional herniation after laparoscopy at the umbilicus, as compared with those at remote sites. From a prospective database of 561 cholecystectomies, 190 inguinal hernia repairs, 71 Nissen fundoplications, and 51 ventral hernia repairs, 873 consecutive Hasson cannula sites, 748 umbilicus sites, and 125 remote sites were analyzed. The wound infection rate was found to be 6%: 7% at the umbilicus (9% after cholecystectomy and 2% after other operations [p < 0.05]) and 0% at remote sites (p < 0.05). Excluding cholecystectomy, the umbilical infection rate was 2%, similar to that at remote sites. The postoperative ventral hernia rate was at 0.8%, the same at the umbilicus as elsewhere. The rate was similar for gallbladder and nongallbladder operations and correlated with the postoperative wound infection rate, but not with the preexisting fascial defect rate. Wound infection at the umbilicus is similar to that at other sites, except after cholecystectomy. Postoperative ventral hernia at the umbilicus is similar to that at other sites and not related to preexisting fascial defects.

Review of major complications of laparoscopy in a free‐standing gynaecological day case hospital

Objectives Our purpose was to review all the major complications of laparoscopy in 6500 consecutive laparoscopies from one centre. We also felt it was important to conduct this study because of the current debate on the use of the Veress needle or the Hasson cannula. Design All the major complications from laparoscopies performed from June 1 1991 to March 31 1995 were documented. This is the largest series from one centre. Each laparoscopy was registered on computer. A distinction between operative and diagnostic laparoscopies was not made by the computer. Results A major complication was defined as one that required laparotomy. In this series eight major complications were recorded. The incidence of major complications was 1.23 per 1000. No vascular injury occurred as a result of using a Veress needle or closed trocar entry. Conclusion Despite advances in operative and diagnostic laparoscopy, complications still occur. From this study there is currently no evidence to suggest that the Veress needle should be banned in favour of the open Hasson technique. The gynaecologist, anaesthetist and consumer need to be aware of the complication rates for gynaecological day surgery laparoscopy.

LAPAROSCOPIC CHOLECYSTECTOMY AND PREVIOUS ABDOMINAL SURGERY: A SAFE TECHNIQUE

Previous abdominal surgery has been cited as a contraindication to the performance of laparoscopic cholecystectomy. The present paper describes a technique whereby a Hasson cannula was introduced into the right iliac fossa by the open technique, using a method similar to an appendicectomy. The laparoscope was then introduced through this port and the safe introduction of other ports was achieved. Any adhesions were divided at this stage. The laparoscope was then moved to the umbilical port and a conventional laparoscopic cholecystectomy performed. In the series of six patients with upper or upper and lower abdominal scars, no patient suffered a complication or required a conversion to laparotomy. However, the operating time was increased from 75 to 105 min. This method involves open introduction of the primary trocar in an area devoid of adhesions. It was shown to be safe and with this method previous abdominal surgery should not be regarded as a contraindication.

Twenty-two years of office and outpatient laparoscopy: Current techniques and why I chose them

Since 1972 I have introduced the following technical modifications in outpatient laparoscopy under local anesthesia to improve safety, economy, and patient acceptability: avoiding the insufflating needle and sharp trocar in favor of open abdominal entry, using the Hasson cannula; introducing room air for insufflation instead of nitrous oxide or carbon dioxide; using the Hulka clip in place of tubal coagulation; making a single-incision, open surgical entry through the central umbilical fossa in obese patients; and completing fascial penetration with a blunt hemostat or Kelly clamp to minimize the risk of bowel or vessel injury.

Critical decisions in 22 years of outpatient laparoscopy

More than 2400 single-incision outpatient laparoscopic operations for sterilization or diagnosis performed by the author over the past 22 years have been influenced by seven critical decisions which were made after reviewing all of the options: 1. Perform procedures on all cooperative patients in free-standing facilities, except in cases with serious medical disorders which require elaborate safeguards and the presence of an anesthesiologist. 2. Administer local anesthesia in all cases. 3. Use the Hasson cannula with blunt obturator for open abdominal entry in every case. 4. Abandon tubal coagulation for sterilization. Instead, perform mechanical tubal occlusion with the Hulka-Lexan Clip. 5. Instill low-volume filtered room air for pneumoperitoneum in place of nitrous oxide. 6. Enter the abdomen through the umbilical fossa in all obese women instead of through the lower rim of the umbilicus. 7. As preliminary steps in abdominal entry in every patient, perforate the partially incised fascia and the parietal peritoneum with a small Kelly clamp or hemostat instead of a scalpel. Each of these seven decisions has, in the author's opinion, improved the technique and safety of outpatient laparoscopy.

A Modified Laparoscopic Entry Technique Using a Finger and Rubber Catheter

Hasson and Grimes have developed the so-called open laparoscopy technique. Patients with surgical history and obese patients present a higher risk for laparoscopy. Since the development of laparoscopic cholecystectomy general surgeons have been able to obtain instruction in percutaneous and open techniques in various laparoscopic training centers throughout the United States. The percutaneous technique uses the Veress needle, while the open technique uses the Hasson cannula. We present a modification of the open technique using a finger and rubber catheter to thread the trocar cannula into the abdomen using standard disposable cannulas and avoiding the use of the Hasson cannula.