Cuan M Harrington1, Dara O Kavanagh2, Sean Tierney3, Richard Deane4, Dermot Hehir5,6. 1. Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland. 2. Department of General Surgery, Tallaght Hospital, Dublin, Ireland. 3. Department of Vascular Surgery, Tallaght Hospital, Dublin, Ireland. 4. Department of Obstetrics and Gynaecology, Trinity College, Dublin, Ireland. 5. Department of Surgery, Midland Regional Hospital Tullamore, Arden Rd, Puttaghan, Tullamore, Co. Offaly, Ireland. dermot.hehir@hse.ie. 6. University of Limerick GEMS, Limerick, Ireland. dermot.hehir@hse.ie.
Abstract
BACKGROUND: With rapidly evolving surgical technologies, minimally invasive surgery (MIS) has become the mainstay approach for many surgeons worldwide. As laparoscopic surgery was introduced in Ireland over two decades ago, we may be encountering a higher prevalence of related complications. AIMS: This study aimed to gather data pertaining to risk factors for port-site herniation in MIS. METHODS: A 14-point anonymous questionnaire was distributed electronically between January and May 2017 to consultant and trainee laparoscopists in the Republic of Ireland. This survey related to laparoscopic volume and surgical approaches to laparoscopic port-sites. RESULTS: There were 172 eligible responses nationally. Approaches to peritoneal access included Hasson, veress (blind puncture) and SILS were 66.3, 32.6 and 1.2%, respectively. Senior surgeons and specialists in Obstetrics and Gynaecology (OBGYN) reported significantly higher utilisations of closed peritoneal access (p < 0.05). Of the participants, 119 (69.2%) reported using a bladeless trocar over a bladed type. Fascial closure was utilised in 94.2% of ≥ 10 mm and 2.3% of 5-mm ports using absorbable suture in 76.7%, non-absorbable suture in 14.5% and port closure devices in 8.7%. Perceptions of risk factors for PSH were not congruent with significant variations in responses between levels of expertise. CONCLUSIONS: This study demonstrates significant variations in laparoscopic port-site practices amongst surgeons nationally. The new era of practitioners may benefit from evidence-based technical workshops and guidelines to increase awareness and reduce potential complications.
BACKGROUND: With rapidly evolving surgical technologies, minimally invasive surgery (MIS) has become the mainstay approach for many surgeons worldwide. As laparoscopic surgery was introduced in Ireland over two decades ago, we may be encountering a higher prevalence of related complications. AIMS: This study aimed to gather data pertaining to risk factors for port-site herniation in MIS. METHODS: A 14-point anonymous questionnaire was distributed electronically between January and May 2017 to consultant and trainee laparoscopists in the Republic of Ireland. This survey related to laparoscopic volume and surgical approaches to laparoscopic port-sites. RESULTS: There were 172 eligible responses nationally. Approaches to peritoneal access included Hasson, veress (blind puncture) and SILS were 66.3, 32.6 and 1.2%, respectively. Senior surgeons and specialists in Obstetrics and Gynaecology (OBGYN) reported significantly higher utilisations of closed peritoneal access (p < 0.05). Of the participants, 119 (69.2%) reported using a bladeless trocar over a bladed type. Fascial closure was utilised in 94.2% of ≥ 10 mm and 2.3% of 5-mm ports using absorbable suture in 76.7%, non-absorbable suture in 14.5% and port closure devices in 8.7%. Perceptions of risk factors for PSH were not congruent with significant variations in responses between levels of expertise. CONCLUSIONS: This study demonstrates significant variations in laparoscopic port-site practices amongst surgeons nationally. The new era of practitioners may benefit from evidence-based technical workshops and guidelines to increase awareness and reduce potential complications.
Authors: Laura Armañanzas; Jaime Ruiz-Tovar; Antonio Arroyo; Pedro García-Peche; Ernesto Armañanzas; María Diez; Isabel Galindo; Rafael Calpena Journal: J Am Coll Surg Date: 2014-02-18 Impact factor: 6.113