Safe techniques for abdominal access and wound closure in laparoscopic surgery.

Laparoscopic surgery requiring tissue morcellation was performed on 66 consecutive patients, using open laparoscopy for primary entry and the SECURE cone technique for accessing the port of mechanical morcellation. Thirty-six patients had laparoscopic myomectomy and 30 had supracervical laparoscopic hysterectomy. In all instances, abdominal entry was accomplished under visual control through a minilaparotomy incision, or using telescopic visualisation. The surgical wound was closed in two layers. The first layer consisted of the fascia at the primary site and the bulk of the abdominal wall at the morcellation site. The skin was approximated loosely. Although no complications were related to the open laparoscopy or SECURE cone techniques, most patients complained of mild to moderate postoperative discomfort related to the SECURE cone site. The discomfort was ameliorated when the bulk closure stitch was tied less tightly. Open laparoscopy and the SECURE cone methods represent safe techniques for primary and secondary abdominal access and wound closure in surgery.