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Surgical Endoscopy

Published in:

01-04-2009

Three simple steps during closed laparoscopic entry may minimize major injuries

Authors: George A. Vilos, Angelos G. Vilos, Basim Abu-Rafea, Jackie Hollett-Caines, Zohreh Nikkhah-Abyaneh, Fawaz Edris

Published in: Surgical Endoscopy | Issue 4/2009

Abstract

Objectives

To describe three steps: (1) the initial Veress pressure (VIP-Pressure), (2) transient high-pressure pneumoperitoneum (HIP-Entry) prior to trocar/cannula insertion, and (3) visual entry with a trocarless cannula during closed laparoscopic entry, which may reduce major injuries.

Design

Prospective observational cohort study (Canadian Task Force Classification II-2).

Setting

University-affiliated teaching hospital.

Interventions

VIP-Pressure. During laparoscopic entry, the initial VIP pressure was measured and correlated against the body habitus and parity of 365 consecutive women. HIP-Entry was performed in 2,498 consecutive cases. In 100 women, the CO₂ volume, heart rate, blood pressure, oxygen saturation, and pulmonary compliance were recorded at pressures of 10, 15, 20, 25, and 30 mmHg. Visual entry with a trocarless blunt cannula was performed in 776 women. The cannula, housing a 0° laparoscope, was rotated clockwise applying minimal downward force.

Measurements and results

VIP-Pressure. Pneumoperitoneum was established after one, two or three Veress needle attempts at the umbilicus in 82.4%, 10.9%, and 4.0% of women, respectively. In seven (2.2%), pneumoperitoneum was established at the left upper quadrant (LUQ) during the fourth attempt, and in two (0.6%) entry was abandoned. Median initial Veress pressure was 4 mmHg (range 2–10 mmHg). The VIP pressure correlated positively with women’s weight (r = 0.518, p < 0.001) and body mass index (BMI) (r = 0.545, p < 0.001), and negatively with parity (r = −0.179, p < 0.001). HIP-Entry. The abdomen was insufflated to 25−30 mmHg prior to primary trocar/cannula insertion. There were no changes in cardiovascular parameters between 15 and 30 mmHg. A 21% decrease in pulmonary compliance from 15 to 30 mmHg was of no clinical significance. No injury has been experienced with the visual cannula in 776 cases.

Conclusions

(1) A VIP-Pressure (<10 mmHg) indicates intraperitoneal placement of the Veress needle. (2) The use of transient HIP-Entry does not adversely affect cardiopulmonary function in healthy women. (3) Visual cannula offers an additional step towards safer entry.

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Title: Three simple steps during closed laparoscopic entry may minimize major injuries
Authors: George A. Vilos
Angelos G. Vilos
Basim Abu-Rafea
Jackie Hollett-Caines
Zohreh Nikkhah-Abyaneh
Fawaz Edris
Publication date: 01-04-2009
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 4/2009
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-008-0060-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Three simple steps during closed laparoscopic entry may minimize major injuries

Abstract

Objectives

Design

Setting

Interventions

Measurements and results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Design

Setting

Interventions

Measurements and results

Conclusions

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