Laparoscopic Access Techniques Research Articles

Features of Performing Single-port Laparoscopic Cholecystectomy

The advantages of endoscopic surgery are well known, which has been confirmed by domestic and world experience in the use of minimally invasive technologies. Along with this, the widespread introduction of operative laparoscopy has led to complications specific to this technology. When performing laparoscopic operations, 3 to 6 trocars are inserted into the abdominal cavity. A large number of undesirable consequences of the introduction of trocars into the abdominal cavity, the so-called trocar complications (iatrogenic damage to internal organs, blood vessels, extraperitoneal insufflation, development of trocar hernias with deterioration of the aesthetic result, increased postoperative pain, increased risk of complications associated with the occurrence of hematomas, wound infections), served as the basis for the search for less invasive techniques. The rapid development of endoscopic surgery has contributed to the emergence of a wide range of surgical methods that do not leave gross scar changes on the skin of the anterior abdominal wall. These include single-port laparoscopic cholecystectomy, which reduces trauma to the anterior abdominal wall and improves cosmetic results. The clinical significance of the single laparoscopic approach (SLA) technique in the surgical treatment of patients with chronic calculous cholecystitis should be substantiated. The study included 116 patients hospitalized for planned surgical treatment with a diagnosis of gallstone disease. Chronic calculous cholecystitis” from 2019 to 2023 on the basis of the National Chemical Center named after M.M. Mamakeev of the Ministry of Health of the Kyrgyz Republic, Bishkek. The use of a single laparoscopic access technique for removing the gallbladder with proper selection of patients and strict adherence to methodological and technical principles makes it possible to achieve better results in the treatment of patients with cholelithiasis with access along the upper edge around the navel than with a longitudinal transubial approach.

Teres lift-up technique: a retrospective comparative study for an alternative route for laparoscopic entry in gynecologic and oncologic surgery.

Laparoscopic surgery is the favored method for the surgical treatment of gynecologic diseases and malignancies. We have defined an anatomic landmark-based, easy-to-perform, and an alternative way of open laparoscopic entry technique named the ligamentum teres lift-up technique (TLU) that can be used in obese or normal-weight women to tackle the risks of the closed laparoscopic entry technique, namely, Veress needle entry (VNE). In this retrospective comparative study, the participants were equally distributed to either the TLU group (n = 36) or the VNE group (n = 36) in a 1:1 ratio. The participants were stratified according to their BMI as follows: BMI between 20-25kg/m2 (average weight), 25-30kg/m2 (overweight), 30-35kg/m2 (class I obesity), and 35-40kg/m2 (class II obesity). Both laparoscopic access techniques were compared according to the entry time, vascular or visceral injuries, insufflation failures, trocar-related complications, and omental damage. The TLU group had a considerably shorter entry time than the VNE group (74.43 ± 21.45s versus 192.73 ± 37.93s; p < 0.001). Only one failed insufflation occurred in the VNE group (p = 0.32); however, that case was successfully insufflated with the TLU technique. Only one intestinal injury was seen in the VNE group, encountered during trocar site closure (p = 0.32). The subgroup analyses of the TLU and VNE groups based on BMI strata revealed a continuation of the statistical significance of entry time between BMI-matched groups. The current study reveals that the new alternative TLU technique supplies an alternative, validated, and rapid access to the abdominal cavity in normal-weight and obese women. This new approach offers an easy-to-teach and easy-to-perform technique for surgical mentors and residents in gynecologic and oncologic surgeries.

Complications in Laparoscopic Access in Standing Horses Using Cannula and Trocar Units Developed for Human Medicine.

First cannulation is a critical manoeuvre in equine laparoscopy. This retrospective study aimed at the comparison of the frequency and type of complications detected when using different human laparoscopy devices for laparoscopic access in standing horses, and the influence of body condition in such complications. Forty-four procedures were included, and retrieved data comprised cannula insertion technique, body condition, and type and frequency of complications. Laparoscopic access techniques were classified into five groups: P: pneumoperitoneum created using Veress needle prior to cannulation; T: sharp trocar; D: direct access via surgical incision; V: Visiport optical trocar and H: optical helical cannula (OHC). In groups T, D, V and H, access was achieved without prior induction of pneumoperitoneum. Complications were registered in 13/44 procedures, of which retroperitoneal insufflation was the most common (6/13). Statistically significant association was found between the complication incidence and the type of access, with group D showing the highest complication frequency (80%) and group H the lowest frequency (0%). The majority of complications (9/13) were observed in overweight horses. We conclude that devices designed for human patients can be used for laparoscopic access in standing horses, with the use of OHC minimizing the appearance of complications, especially in overweight horses with OW.

Laparoscopic resection of a bladder diverticulum in children

Introduction. Recently, there have been publications devoted to laparoscopic removal of a bladder ear. The article sums up the multi-center experience in laparoscopic diverticulectomy.Materials and methods. Case histories of 30 children who underwent surgeries from 2012 to 2019 in 7 outpatient clinics were analyzed retrospectively. 22 boys (73.3%) and 8 girls (26.7%) were operated. At the time of the surgery, the mean age of the patients was 53.5 months. 15 (50.0%) children had right-sided diverticulum, 13 (43.3%) children suffered from left-sided one, and 2 had bilateral diverticulum (6.7%). The disease onset was presented by acute urinary tract infection in 25 (83.3%) children and urination dysfunction in 5 (16.7%). The laparoscopic access technique was used in all children. An isolated diverticulum was excised and the wall of the urinary bladder was restored. When the diverticulum was combined with a vesicoureteral reflux or ureterovesical anastomosis, ureteral reimplantation was added. Results. No conversions were found during the laparoscopy. Following the surgery, 3 (10.0%) children developed stent-associated pyelonephritis. No patient had complications during the observation that lasted from 6 months to 6 years. Conclusion. Laparoscopic technique is an effective and safe approach of treating a bladder ear in children.

Laparoscopic Access Techniques: Experience in a Developing Country, Sudan

Background: Minimal access surgery has revolutionized the field of surgery. Access to the abdominal cavity represents a critical step in laparoscopic procedures. Various techniques have been used to obtain safe access into the abdominal cavity, with no apparent superiority of one technique over another. Aim: This study was conducted to assess the different types of laparoscopic access techniques used at Almak Nimir University Hospital in the period from January to December 2019. Methodology: This descriptive cross-sectional study compared the use and outcomes of different laparoscopic access techniques in various laparoscopic procedures performed at Almak Nimir University Hospital, (Shendi University, Shendi, Sudan). Results: The study included 324 patients with a mean age of 26.2±15.3 years (range 1–85 years). Most of the patients were female (266 patients, 82.1%). Of the laparoscopic procedures, 77.2% were laparoscopic appendicectomy while 18.8% were laparoscopic cholecystectomy. The Veress needle technique was used in 158 patients (49.7%), the open technique was used in 97 patients (29.9%) and direct trocar insertion was used in 66 patients (20.4%). Direct trocar insertion showed a statistically shorter procedure duration (mean 2.9±0.9 min) compared to the other techniques (p=0.001). Access-related complications occurred in five patients (0.6%), but there was no statistically significant difference between the three access techniques. Conclusion: This study confirms the safety of various access techniques used in laparoscopic procedures; however, the choice of access type should be individualized.

Comparativa entre 2 técnicas de insuflación laparoscópica cerrada con aguja de Veress. Estudio prospectivo multicéntrico de 300 casos

ObjectiveTo demonstrate that the laparoscopic access technique at Palmer's point at elevated pressures does not cause significant anaesthetic adverse effects in healthy patients, and is also useful for reducing the risk of major injuries compared to the classic umbilical insufflation technique at standard pressures. Material and methodsProspective observational analytical study of cohorts. The cohort exposed to the studied factor consisted of 150 patients undergoing gynaecological laparoscopic surgery in which insufflation with Veress needle in Palmeŕs point until high pressures of 20-25mmHg (Group 1) has been used for access manoeuvres into the abdominal cavity. The unexposed cohort consisted of 150 patients in whom the classical technique of insufflation has been used for access manoeuvres to the abdominal cavity, with the needle at umbilical level up to standard pressures of 12-14mmHg (Group 2). ResultsThe percentage of complications in Group 1 was 5.3%, whereas it was 6.7% in Group 2 (p=0.62). On the other hand, the percentage of technique changes/access location and conversion to laparotomy due to adverse effects during insufflation/entry manoeuvres was 2% and 0% in Group 1, and 2.7% and 2% in Group 2, respectively. ConclusionPalmer's point insufflation at elevated pressures has advantages compared to the classical umbilical technique, as regards the prevention of complications during laparoscopic access manoeuvres.

Laparoscopic access overview: Is there a safest entry method?

BackgroundLaparoscopy is a minimally invasive technique to access the abdominal cavity, for diagnostic or therapeutic applications. Optimizing the access technique is an important step for laparoscopic procedures. The aim of this study is to assess the outcomes of different laparoscopic access techniques and to identify the safest one. MethodsLaparoscopic access questionnaire was forwarded via e-mail to the 60 centers who are partners in working group for laparoscopic and robotic surgery of the Italian Urological Society (SIU) and their American and European reference centers. ResultsThe response rate was 68.33%. The total number of procedures considered was 65,636. 61.5% of surgeons use Veress needle to create pneumoperitoneum. Blind trocar technique is the most commonly used, but has the greatest number of complications. Optical trocar technique seems to be the safest, but its the less commonly used. The 28.2% of surgeons adopt open Hasson's technique. Total intra-operative complications rate was 3.3%. Open conversion rate was 0.33%, transfusion rate was 1.13%, and total post-operative complication rate was 2.53%. ConclusionLaparoscopic access is a safe technique with low complication rate. Most of complications can be managed conservatively or laparoscopically. The choice of access technique can affect the rate and type of complications and should be planned according to surgeon experience, safety of each technique and patient characteristics. All access types have perioperative complications. According to our study, optical trocar technique seems to be the safest.

Revisión del acceso laparoscópico: ¿hay un método de entrada más seguro?

BackgroundLaparoscopy is a minimally invasive technique to access the abdominal cavity, for diagnostic or therapeutic applications. Optimizing the access technique is an important step for laparoscopic procedures. The aim of this study is to assess the outcomes of different laparoscopic access techniques and to identify the safest one. MethodsLaparoscopic access questionnaire was forwarded via e-mail to the 60 centers who are partners in working group for laparoscopic and robotic surgery of the Italian Urological Society (SIU) and their American and European reference centers. ResultsThe response rate was 68.33%. The total number of procedures considered was 65.636. 61.5% of surgeons use Veress needle to create pneumoperitoneum. Blind trocar technique is the most commonly used, but has the greatest number of complications. Optical trocar technique seems to be the safest, but it's the less commonly used. The 28,2% of surgeons adopt open Hasson's technique. Total intra-operative complications rate was 3.3%. Open conversion rate was 0.33%, transfusion rate was 1.13%, and total post-operative complication rate was 2.53%. ConclusionLaparoscopic access is a safe technique with low complication rate. Most of complications can be managed conservatively or laparoscopically. The choice of access technique can affect the rate and type of complications and should be planned according to surgeon experience, safety of each technique and patient characteristics. All access types have perioperative complications. According with our study, optical trocar technique seems to be the safest.

1185 “CLOSED” ACCESS IN PEDIATRIC UROLOGIC LAPAROSCOPY—A VIABLE ALTERNATIVE TO “OPEN” ACCESS IN A LARGE, CONTEMPORARY SERIES

You have accessJournal of UrologyPediatrics: Reconstructive Surgery1 Apr 20111185 “CLOSED” ACCESS IN PEDIATRIC UROLOGIC LAPAROSCOPY—A VIABLE ALTERNATIVE TO “OPEN” ACCESS IN A LARGE, CONTEMPORARY SERIES Eric Nelson, Harsha Mittakanti, Shelly Bian, Kirk Jackson, David Roth, and Lars Cisek Eric NelsonEric Nelson Houston, TX More articles by this author , Harsha MittakantiHarsha Mittakanti Houston, TX More articles by this author , Shelly BianShelly Bian Houston, TX More articles by this author , Kirk JacksonKirk Jackson Houston, TX More articles by this author , David RothDavid Roth Houston, TX More articles by this author , and Lars CisekLars Cisek Houston, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.818AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The use of laparoscopy in pediatric urologic surgery is now routine. Placement of the initial trocar is a critical step and avoidance of bowel and major vessel injury is paramount. The ideal technique for placement has not been explored in the pediatric urologic literature. We hypothesize that a “closed” access method is technically straight-forward, safe, and can be applied to routine pediatric urologic operations. METHODS An Institutional Review Board-approved retrospective chart review was performed of all patients undergoing laparoscopic surgery between 2003 and 2010. Data extracted included: age, procedure, previous surgical history, method and location of access, presence or absence of intra-abdominal adhesions, and intra-operative complications. Method of access was classified as either “open” (Hassan) or “closed” which included: the direct technique, optical access with a Visiport, or use of a Veress needle/Step Trocar system. For the direct access technique, an umbilical incision is made and the skin on either side is elevated in a “lifted table” technique. A bladeless trocar is then pushed and twisted with gentle, firm pressure through the rectus fascia. Intra-abdominal position is confirmed visually and the abdomen is then insufflated. In the Veress/Step Trocar group, a Veress needle confirmed intra-abdominal position and the timing of insufflation varied. RESULTS 668 encounters (631 patients) were identified and average age was 7.53 years (0.13–19.68). The procedures were performed by five surgeons and encompassed a variety of procedures (orchiopexy- related—179, inguinal hernia repair—180, varicocelectomy—160, ureteral reimplant—31, pyeloplasty—102). A “closed” access technique was utilized in 661/668 encounters (direct—475; Veress/Step—164; Visiport—20). 12.3% of the patients had a history of intra-abdominal surgery and significant adhesions were seen in 14 (2.1%). There was one complication during access—a small liver laceration during initial port placement for a pyeloplasty. The bleeding was minimal and required no intervention. An open technique was chosen in seven patients—five of these had concomitant umbilical hernia repair. CONCLUSIONS The “closed” technique for laparoscopic access in the pediatric population is safe and feasible even in patients with previous intra-abdominal surgery. We believe the technique is technically straight-forward and efficient. These data support “closed” access techniques as viable alternatives to the Hassan method for routine use in pediatric laparoscopy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e476 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eric Nelson Houston, TX More articles by this author Harsha Mittakanti Houston, TX More articles by this author Shelly Bian Houston, TX More articles by this author Kirk Jackson Houston, TX More articles by this author David Roth Houston, TX More articles by this author Lars Cisek Houston, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Treatment Options and Outcomes for Celiac Artery Compression Syndrome

Abdominal pain attributed to compression of the celiac artery at the level of the median arcuate ligament (MAL) of the diaphragm is an uncommon disorder. Although ultrasound investigation and arteriography can be suggestive of the diagnosis, no definitive criteria exist with only cases reports in the literature. This study presents the only known reported case series in which a combination of open and laparoscopic access techniques of MAL decompression are reported. A retrospective review of prospectively collected electronic databases of the University of North Carolina at Chapel Hill was performed for the period February 1999 until February 2009. Patients having undergone operation for celiac artery compression syndrome were identified and participated in a telephone interview. Questions were asked about the success of the operation, the recovery period, and patient satisfaction. Six patients were identified, 3 were male; mean age was 37.7 years. Four underwent open MAL division and celiac ganglion neurolysis, and 2 underwent a laparoscopic approach. Mean follow-up was 48.6 months. All patients experienced symptomatic improvement and were satisfied with their outcome. No patient had symptoms recurrence. In this limited experience, MAL division with celiac ganglion neurolysis appears to be an effective treatment for celiac artery compression syndrome in appropriately selected patients. Both the open and laparoscopic approaches are safe with durable midterm follow-up results.

Abdominal access in gynaecological laparoscopy: a comparison between direct optical and blind closed access by Verres needle

Objective : Complications associated with initial abdominal entry are a prime concern for laparoscopic surgeons. In order to minimize first access-related complications in laparoscopy, several techniques and technologies have been introduced in the past years. This investigation compares two laparoscopic access techniques. Study design : 194 women underwent laparoscopic surgery for simple ovarian cysts: 93 were assigned to direct optical access (DOA) abdominal entry (group I), and 101 women to classical closed method by Verres needle, pneumoperitoneum and trocar entry (group II). The following parameters were compared: time required for entry into abdomen, occurrence of vascular and/or bowel injury, blood loss. The results were analyzed using SAS software. p-value < 0.05 was considered as significant. Results : No statistically significant differences were observed in the occurrence of blood loss and minor vascular injury between the two techniques, as well as minor bowel injuries; time for of abdominal entry, instead, were significantly reduced in the DOA group. Conclusions : The results of the preliminary comparison between the DOA and the Verres methods, commonly used by gynecologists, suggests that the visual entry system confers a statistical advantage over closed entry technique with Verres needle, in terms of time saving and due to the minor vascular and bowel injuries, thus enabling a safe and expeditious, visually-guided, entry for surgeons.

Initial laparoscopic access in postmenopausal women

Estrogen loss at menopause has a profound influence on skin, with postmenopausal atrophy and loss of tone and elasticity. Because more than 50% of major laparoscopic complications occur during initial entry under the abdominal skin, the efficacy and the safety of two laparoscopic access techniques were compared in postmenopausal women. One hundred eighty-six postmenopausal women underwent laparoscopic surgery for simple ovarian cysts: 89 were assigned to direct optical access (DOA), abdominal entry (group I), and 97 to the classic closed Veress needle approach, pneumoperitoneum, and trocar entry (group II). The following parameters were compared: time needed for entry into the abdomen, occurrence of vascular and/or bowel injury, and blood loss. Results were analyzed using SAS software, considering P value less than 0.05 as significant. No statistically significant differences were observed in the occurrence of major vascular and/or bowel injury between the two techniques (P > 0.05), whereas time for abdominal entry was significantly reduced in the DOA group, as well as the occurrence of minor vascular injuries (P < 0.05). Results of this preliminary comparison on the DOA and the Veress methods, commonly used by gynecologists, suggest that the visual entry system offers a statistical advantage over the closed Veress needle approach, in terms of time saving and limiting minor vascular injuries, thus enabling a safe and fast visually guided entry in postmenopausal women.

Abdominal Access in Gynaecologic Laparoscopy: A Comparison Between Direct Optical and Open Access

More than 50% of major laparoscopic complications occur during the initial entry into the abdomen. We investigated the efficacy and the safety of two laparoscopic access techniques: the direct optical access (DOA) versus the classical open entry, as described by Hasson. Two hundred and two premenopausal women, homogeneous in age, parity, and body mass index undergoing laparoscopic surgery for simple ovarian cysts, were prospectively, randomly assigned to either open or DOA abdominal entry for laparoscopic surgery. The following parameters were compared: duration of access for entry into the abdomen, occurrence of vascular and/or bowel injury, and blood loss. The results were analyzed by using SAS software (SAS Institute, Inc., Cary, NC), considering a P-value of <0.05 as significant. No statistically significant differences were observed in the occurrence of major vascular and/or bowel injury between the two techniques. However, time for establishment of abdominal entry was significantly reduced in the DOA group, as was the blood loss (P < 0.05). The results of this preliminary comparison on the DOA and the Hasson methods, commonly used by general surgeons and less frequently by gynecologists, suggest that the visual entry system confers a little statistical advantage over the traditional Hasson entry, in terms of safety, minimal time saving, and in reducing blood loss, allowing a safe, fast, visually guided entry.

Comparison of Laparoscopic and Open Partial Nephrectomy for Duplication Anomalies in Children

We compared the outcome of laparoscopic vs open PN for duplication anomalies at our institution. We retrospectively reviewed the records of all patients undergoing PN within the last 4 years. A total of 34 patients (16 females) were divided into 2 groups. Group 1 consisted of 20 patients undergoing open PN between 2000 and 2003, and group 2 consisted of 14 patients undergoing laparoscopic PN between 2003 and 2004. Mean patient age was 21 months in group 1 and 18 months in group 2. Diagnosis was ectopic ureter in 18 patients, ureterocele in 11, VUR in 4 and ureteropelvic junction obstruction in 1. Cystoscopy was performed as part of the procedure in 30% of the patients in group 1 and 100% of those in group 2. Simultaneous lower tract procedures were performed in 3 patients in group 1 and 2 patients in group 2. Mean duration of PN was 115 minutes for group 1 and 180 minutes for group 2. There was no significant bleeding or need for transfusion except in 1 patient in the open group. Median hospitalization was 3 days for group 1 and 2 days for group 2. Mean analgesic requirement was 2.3 doses of opioids and 2 doses of ketorolac for group 1, and 3.2 doses of opioids for group 2. Acetaminophen only was used in 3 of 20 patients in group 1 and 5 of 14 in group 2. There were 2 complications in each group, namely 1 case of ureteral bleeding and 1 lower pole ureteral injury in group 1, and 1 omental hernia and 1 urinoma in group 2. Laparoscopic PN is feasible even in small infants, and the results are comparable to the open procedure. Length of hospitalization was shorter in the laparoscopic group. In our series the learning curve for this technique was rapid, and after a few cases the procedure could be done in the same time as open surgery, with the advantages offered by laparoscopy.

Safe and Rapid Laparoscopic Access—a New Approach

Despite numerous recent technical advances in minimally invasive surgical technique, the potential exists for serious morbidity during initial laparoscopic access. Safe access depends on adhering to well-recognized principles of trocar insertion, knowledge of abdominal anatomy, and recognition of hazards imposed by previous surgery. Applying these principles, we describe a safe, rapid, and cost-effective technique for laparoscopic access using readily available instruments. This technique emphasizes identification and incision of the point at which the midline abdominal fascia is fused with the base of the umbilicus, and the importance of the application of countertraction directly at the point of insertion. This method allows penetration under direct vision with minimal controlled axial force, and without the requirement for fascial sutures or other cumbersome aspects of the traditional open technique. While previous reports describe techniques for laparoscopic access entry based on similar anatomic and surgical principles, we describe an alternative method not yet discussed in the surgical literature.

The Safety and Efficacy of Direct Trocar Insertion With Elevation of the Rectus Sheath Instead of the Skin for Pneumoperitoneum

Abdominal access in endoscopic surgery carries a finite risk of visceral injury. Bleeding, subcutaneous emphysema, gastrointestinal tract perforation, minor and major vascular injury, and intraperitoneal adhesions are the potential complications associated with abdominal access and creation of pneumoperitoneum. There are 4 basic techniques used to create pneumoperitoneum: blind Veress needle, direct trocar insertion, optical trocar insertion, and open laparoscopy. Veress needle and direct trocar insertion are blind techniques, and their use can result in severe visceral and vascular injuries. To prevent visceral and vascular injuries caused by the technique used for the creation of pneumoperitoneum, laparoscopic surgeons and gynecologists look for safe and effective laparoscopic access techniques. Direct trocar insertion without previous pneumoperitoneum was reported to be a safe alternative to Veress needle insertion. We carried out this study to compare the ease of use, safety, and efficacy of direct trocar insertion with elevation of the rectus sheath and blind insertion of the Veress needle in laparoscopic surgery. In 578 laparoscopic procedures, the patients were assigned to one of the following groups: blind insertion of the Veress needle (group 1, n = 301) and direct trocar insertion with elevation of the rectus sheath using 2 towel clips (group 2, n = 277). Total complication rates were 15.7% (n = 33) and 3.3% (n = 4) in groups 1 and 2, respectively (P < 0.05). Direct trocar insertion with elevation of the rectus sheath using 2 towel clips is an easy, safe, and effective technique.

Experience With the Bailez Technique for Laparoscopic Access in Children

We describe a variation of the Hasson technique for laparoscopic access. All laparoscopic procedures performed in children and completed between September 1999 and May 2002 at 2 institutions were reviewed retrospectively. All access to the peritoneal cavity was accomplished in the same manner using the following approach-a small semicircumferential incision was made in the inferior part of the umbilicus, and the umbilical skin was dissected to expose the area of the umbilical scar where the peritoneum and the skin meet. At this point the peritoneum was opened under direct vision without an incision. A blunt trocar was then easily introduced into the peritoneal cavity without forceful manipulation. The rest of the procedure was accomplished as usual. Seventy-seven laparoscopic procedures were completed in 77 patients (mean age 4.8 years, range 1 month to 17.75 years). Patient weight ranged from 8 to 66 kg. The procedures included diagnostic laparoscopy for undescended testis (52), varicocelectomy (11), nephrectomy (6), nephroureterectomy (1) and others (7). All attempts were successful. Mean followup was 15.9 months. The most important advantage of this technique is that it offers easy and safe access to the peritoneal cavity even in obese individuals. In addition, this access is rapidly accomplished and offers good cosmetic results.

The Feasibility of Open Laparoscopy in Gynecologic–Oncologic Patients

Gynecologic–oncologic patients are at increased risk for complications with closed laparoscopy. Open laparoscopy eliminates the steps of blind insufflation and trocar insertion. This study is the first large series of open laparoscopies to assess the feasibility and safety of the open laparoscopy technique in patients with gynecologic malignancies. We performed 90 open laparoscopies in 89 oncologic patients with previous major surgery (65%) and/or radiotherapy (17%) or a large omental cake (18%). Complications due to the laparoscopic access technique occurred in one patient (1%) for whom a laparotomy was performed for a small bowel perforation. The incidence of complications of the open laparoscopy technique (1%) is favorable compared to the complication rate of closed laparoscopy in gynecologic–oncologic patients. It is concluded that open laparoscopy is a safe and feasible technique in gynecologic–oncologic patients.