Vascular and Bowel Injuries from Blind and Open Access Techniques in Laparoscopy
/ 0
- Details
- Category: Vol. 77, December 2009
- Hits: 605
Vascular and Bowel Injuries from Blind and Open Access Techniques in Laparoscopy,TAMER M. NABIL and NADER SHABAAN
Abstract
Objective: This report evaluates access-related complica-tions with both blind and open access techniques in a teaching hospital using standardized techniques for both methods with the aim is to alert to potential hazards and to suggest methods and practices to minimize these often catastrophic events while offering patients all the benefits of the minimal access approach.
Methods: Two groups of patients at different times from a prospective database were compared. A retrospective analysis of 1,197 patients treated using blind access between Sep. 1998 and Sep. 2006 were compared with 352 patients treated using open step-by-step access between Dec. 2004 and Sep. 2006 regarding access-related complications.
Results: In blind access group there were 4 cases of vascular injury (.33%); all cases were evaluated immediately and required laparotomy, provisional haemostasis and urgent attendance by a vascular surgeon in 3 cases. There was no further postoperative Complications in all cases and 1 case of bowel injury (.08%) from shielded trocar leading to perfo-ration of sigmoid Colon repaired laparoscopically by sutures in 2 layers with no further postoperative complications.
Open step-by-step access shows no vascular or bowel injuries (0%).
Conclusion: Because no evidence exists to show that the blind access technique is superior in any aspect, the open technique is recommended for access to the abdominal cavity in laparoscopy. In cases when blind access technique is preferable (No cannula will be put around the umbilicus and/or Patient is morbidly obese), Blind Veress needle insertion in left subcostal area at point between left midclavicular and anterior axillary lines and insufflation followed by optical-access trocar insertion is the preferred method for first cannula insertion.