N Dunne1, M I Booth, T C B Dehn. 1. Department of General Surgery, Royal Berkshire Hospital, Reading, UK. nikkidunne@hotmail.com
Abstract
INTRODUCTION: The technique of establishing pneumoperitoneum for laparoscopic surgery remains contentious, with various different techniques available and each having its own advocates. The Verres needle approach has attracted much criticism and is seen to entail more risk, but is this view justified in the era of evidence-based medicine? PATIENTS AND METHODS: Over a 6-year period, a prospective study was undertaken of 3126 patients who underwent laparoscopic surgery performed by two upper gastrointestinal surgeons. One surgeon preferred the Verres needle and the other an open technique. A database was created of all cases and complication rates of the different techniques ascertained. RESULTS: Peri-umbilical Verres needle was used in 1887 cases (60.4%) with two complications encountered, both of which were colonic injuries, with an incidence of 0.1%. Open port insertion was used in 1200 cases (38.4%) with one complication, a small bowel perforation, to give an incidence of 0.08%. The Verres needle was used in alternative positions in 22 cases (0.75%) and, when used in the left upper quadrant (19 cases), there was one complication, a left hepatic lobe puncture, with an incidence of 5.26%. Our overall incidence of intra-abdominal injury was 0.13%, all in patients who had undergone previous abdominal surgery, and in the subgroup of patients with previous surgery the rate was 0.78%. There was no mortality. CONCLUSIONS: Practice varies as to the method chosen to induce pneumoperitoneum, but our results show there is no significant difference between the technique chosen and incidence of complications, and this is supported in the literature.
INTRODUCTION: The technique of establishing pneumoperitoneum for laparoscopic surgery remains contentious, with various different techniques available and each having its own advocates. The Verres needle approach has attracted much criticism and is seen to entail more risk, but is this view justified in the era of evidence-based medicine? PATIENTS AND METHODS: Over a 6-year period, a prospective study was undertaken of 3126 patients who underwent laparoscopic surgery performed by two upper gastrointestinal surgeons. One surgeon preferred the Verres needle and the other an open technique. A database was created of all cases and complication rates of the different techniques ascertained. RESULTS: Peri-umbilical Verres needle was used in 1887 cases (60.4%) with two complications encountered, both of which were colonic injuries, with an incidence of 0.1%. Open port insertion was used in 1200 cases (38.4%) with one complication, a small bowel perforation, to give an incidence of 0.08%. The Verres needle was used in alternative positions in 22 cases (0.75%) and, when used in the left upper quadrant (19 cases), there was one complication, a left hepatic lobe puncture, with an incidence of 5.26%. Our overall incidence of intra-abdominal injury was 0.13%, all in patients who had undergone previous abdominal surgery, and in the subgroup of patients with previous surgery the rate was 0.78%. There was no mortality. CONCLUSIONS: Practice varies as to the method chosen to induce pneumoperitoneum, but our results show there is no significant difference between the technique chosen and incidence of complications, and this is supported in the literature.
Authors: Johann Nicholas; Mark Thomas; Roger Adkins; Kanwaljit Sandhu; Steve Smith; Jonathan Odum; Indranil Dasgupta Journal: Perit Dial Int Date: 2014 Jul-Aug Impact factor: 1.756
Authors: Andrea Tinelli; Antonio Malvasi; Ospan A Mynbaev; Daniel Alberto Tsin; Fausto Davila; Guillermo Dominguez; Emanuele Perrone; Farr R Nezhat Journal: JSLS Date: 2013 Oct-Dec Impact factor: 2.172