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Laparoscopic Access Techniques: Experience in a Developing Country, Sudan

Received: 6 May 2020     Accepted: 26 May 2020     Published: 16 June 2020
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Abstract

Background: Minimal access surgery has revolutionized the field of surgery. Access to the abdominal cavity represents a critical step in laparoscopic procedures. Various techniques have been used to obtain safe access into the abdominal cavity, with no apparent superiority of one technique over another. Aim: This study was conducted to assess the different types of laparoscopic access techniques used at Almak Nimir University Hospital in the period from January to December 2019. Methodology: This descriptive cross-sectional study compared the use and outcomes of different laparoscopic access techniques in various laparoscopic procedures performed at Almak Nimir University Hospital, (Shendi University, Shendi, Sudan). Results: The study included 324 patients with a mean age of 26.2±15.3 years (range 1–85 years). Most of the patients were female (266 patients, 82.1%). Of the laparoscopic procedures, 77.2% were laparoscopic appendicectomy while 18.8% were laparoscopic cholecystectomy. The Veress needle technique was used in 158 patients (49.7%), the open technique was used in 97 patients (29.9%) and direct trocar insertion was used in 66 patients (20.4%). Direct trocar insertion showed a statistically shorter procedure duration (mean 2.9±0.9 min) compared to the other techniques (p=0.001). Access-related complications occurred in five patients (0.6%), but there was no statistically significant difference between the three access techniques. Conclusion: This study confirms the safety of various access techniques used in laparoscopic procedures; however, the choice of access type should be individualized.

Published in Journal of Surgery (Volume 8, Issue 4)
DOI 10.11648/j.js.20200804.12
Page(s) 109-113
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Laparoscopic Access, Veress Needle, Blind Trocar Insertion, Open, Pneumoperitoneum

References
[1] Frampton S, Kneebone RL. John Wickham's new surgery: 'minimally invasive therapy', innovation, and approaches to medical practice in twentieth-century Britain. Soc Hist Med. 2017; 30 (3): 544–566. doi: 10.1093/shm/hkw074.
[2] Shabanzadeh DM, Sorensen LT. Laparoscopic surgery compared with open surgery decreases surgical site infection in obese patients: a systematic review and meta-analysis. Ann Surg. 2012; 256 (6): 934–945.
[3] Ahmad G, Baker J, Finnerty J, Phillips K, Watson A. Laparoscopic entry techniques. Cochrane Database Syst Rev. 2019, John Wiley & Sons, Ltd, 1, ISSN 1465-1858, DOI 10.1002/14651858.CD006583.pub5.
[4] Opilka MN, Lorenc Z, Starzewski J. Laparoscopic access techniques. In: Darwish A. (ed.) Advanced Gynecologic Endoscopy. IntechOpen; 2011. doi: 10.5772/18927. Available from: https: //www.intechopen.com/books/advanced-gynecologic-endoscopy/laparoscopic-access-techniques, p 90-104.
[5] Vilos G, Lefebvre G, Allaire C, Arneja J, Birch C, Dempsey T, et al. Laparoscopic entry: a review of techniques, technologies, and complications. J Obstet Gynaecol Can. 2007; 29 (5): 433–447.
[6] Angioli R, Terranova C, De Cicco Nardone C, Cafà EV, Damiani P, Portuesi R, et al. A comparison of three different entry techniques in gynecological laparoscopic surgery: a randomized prospective trial. Eur J Obstet Gynecol Reprod Biol. 2013; 171 (2): 339.
[7] Kaistha S, Kumar A, Gangavatiker R, Br S, Sisodiya N. Laparoscopic access: direct trocar insertion versus open technique. J Laparoendosc Adv Surg Tech A. 2019; 29 (4): 489–494.
[8] Krishnakumar S, Tambe P. Entry complications in laparoscopic surgery. J Gynecol Endosc Surg. 2009; 1 (1): 4–11.
[9] Passerotti CC, Nguyen HT, Retik AB, Peters CA. Patterns and predictors of laparoscopic complications in pediatric urology: the role of ongoing surgical volume and access techniques. J Urol. 2008; 180: 681–685.
[10] Branco AW, Urologic surgery laparoscopic access: vascular complications. Int Braz J Urol. 2017; 43 (1): 168.
[11] Johnson TG, Hooks WB, Adams A, Hope WW. Safety and efficacy of laparoscopic access in a surgical training program. Surg Laparosc Endosc Percutan Tech. 2016; 26 (4): 17–20.
[12] Hasson HM. A modified instrument and method for laparoscopy. Am J Obstet Gynecol. 1971; 110 (6): 886–887.
[13] Ogaick M, Martel G. Advances in abdominal access for laparoscopic surgery: a review. Open Access Surgery. 2014; 7 (9): 81–88.
[14] Nguyen NT, DeMaria E, Ikramuddin S, Hutter MM. The SAGES Manual. In: SAGES, editor. Berlin, Germany: Springer; 2012.
[15] Choudhury DK, Kaman A. Direct trocar entry technique: asafe method of primary trocar entry in laparoscopic surgery. Journal of Dental and Medical Sciences. 2017; 16 (12): 38–40.
[16] Compeau C, McLeod NT, Ternamian A. Laparoscopic entry: a review of Canadian general surgical practice. Can J Surg. 2011; 54 (5): 315–320.
[17] Bianchi G, Martorana E, Ghaith A, Pirola GM, Rani M, Bove P, et al. Laparoscopic access overview: is there a safest method entry method? Actas Urol Esp. 2016; 40: 386–392.
[18] Cuss A, Bhatt M, Abbott J. Coming to terms with the fact that the evidence for laparoscopic entry is as good as it gets. J Minim Invasive Gynecol. 2015; 22 (3): 332–341.
[19] Wolthuis AM. Veress needle creation of a pneumoperitoneum: is it risky? Results of the first Belgian group for endoscopic surgery-snapshot study. JLaparoendoscop Adv Surg Tech. 2019; 29 (8): 1023–1026. http: //doi.org/10.1089/lap.2019.0243.
[20] Rashid Aslam MK, Shamsi H, Gul A, Aman Z. Frequency of common complications of veress needle used for creating pneumoperitoneum in laparoscopic cholecystectomy. KJMS. 2018 Sep; 11 (3): 435.
[21] Nevler A, Har-Zahav G, Rosin D, Gutman M. Safer trocar insertion for closed laparoscopic access: ex vivo assessment of an improved Veress needle. Surg Endosc. 2015; 30 (2): 779–782.
[22] Kovachev S, Ganovska A, Atanasova V, Sergeev S, Mutafchiyski V, Vladov N. Open laparoscopy--a modified Hasson technique. Akush Ginekol (Sofiia). 2015; 54 (4): 52–56.
[23] Nuzzo G, Giuliante F, Tebala GD, Vellone M, Cavicchioni C, Routine use of open technique in laparoscopic operations. J Am Coll Surg. 1997; 184 (1): 58–62.
[24] Bonjer HJ, Hazebroek EJ, Kazemier G, Giuffrida MC, Meijer WS, Lance JF. Open versus closed establishment of pneumoperitoneum in laparoscopic surgery. Br J Surg. 1997; 84 (5): 599–602.
[25] McKernan JB, Champion JK. Access techniques: Veress needle--initial blind trocar insertion versus open laparoscopy with the Hasson trocar. Endosc Surg Allied Technol. 1995; 3 (1): 35–38.
[26] Jansen FW, Kolkman W, Bakkum EA, de Kroon CD, Trimbos-Kemper TC, Trimbos JB. Complications of laparoscopy: an inquiry about closed- versus open-entry technique. Am J Obstet Gynecol. 2004; 190 (3): 634–638.
[27] Godara R, Bansal AR, Verma S, Yadav S, Verma N, Gupta S. Direct trocar insertion without the pneumoperitoneum in laparoscopic surgery-Is this a safe technique? Hellenic Journal of Surgery. 2015; 87 (5); 415–418.
[28] ErtugrulI, Kayaap C, Yagci MA, Sumer F, Karagul S, Tolan K. Comparison of direct trocar entry and Veress needle entry in laparoscopic bariatric surgery: randomized contolled trial. J Laparosc Adv Surg Tech A. 2015; 25 (11): 875–879.
[29] Catarci M, Carlini M, Gentileschi P, Santoro E. Major and minor injuries during the creation of pneumoperitoneum. A multicenter study on 12,919 cases. Surg Endosc. 2001; 15 (6): 566–569.
Cite This Article
  • APA Style

    Mohanned Omer Abass, Elssayed Osman Elssayed, Abdelrahman Babekir Mhammed. (2020). Laparoscopic Access Techniques: Experience in a Developing Country, Sudan. Journal of Surgery, 8(4), 109-113. https://doi.org/10.11648/j.js.20200804.12

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    ACS Style

    Mohanned Omer Abass; Elssayed Osman Elssayed; Abdelrahman Babekir Mhammed. Laparoscopic Access Techniques: Experience in a Developing Country, Sudan. J. Surg. 2020, 8(4), 109-113. doi: 10.11648/j.js.20200804.12

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    AMA Style

    Mohanned Omer Abass, Elssayed Osman Elssayed, Abdelrahman Babekir Mhammed. Laparoscopic Access Techniques: Experience in a Developing Country, Sudan. J Surg. 2020;8(4):109-113. doi: 10.11648/j.js.20200804.12

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  • @article{10.11648/j.js.20200804.12,
      author = {Mohanned Omer Abass and Elssayed Osman Elssayed and Abdelrahman Babekir Mhammed},
      title = {Laparoscopic Access Techniques: Experience in a Developing Country, Sudan},
      journal = {Journal of Surgery},
      volume = {8},
      number = {4},
      pages = {109-113},
      doi = {10.11648/j.js.20200804.12},
      url = {https://doi.org/10.11648/j.js.20200804.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20200804.12},
      abstract = {Background: Minimal access surgery has revolutionized the field of surgery. Access to the abdominal cavity represents a critical step in laparoscopic procedures. Various techniques have been used to obtain safe access into the abdominal cavity, with no apparent superiority of one technique over another. Aim: This study was conducted to assess the different types of laparoscopic access techniques used at Almak Nimir University Hospital in the period from January to December 2019. Methodology: This descriptive cross-sectional study compared the use and outcomes of different laparoscopic access techniques in various laparoscopic procedures performed at Almak Nimir University Hospital, (Shendi University, Shendi, Sudan). Results: The study included 324 patients with a mean age of 26.2±15.3 years (range 1–85 years). Most of the patients were female (266 patients, 82.1%). Of the laparoscopic procedures, 77.2% were laparoscopic appendicectomy while 18.8% were laparoscopic cholecystectomy. The Veress needle technique was used in 158 patients (49.7%), the open technique was used in 97 patients (29.9%) and direct trocar insertion was used in 66 patients (20.4%). Direct trocar insertion showed a statistically shorter procedure duration (mean 2.9±0.9 min) compared to the other techniques (p=0.001). Access-related complications occurred in five patients (0.6%), but there was no statistically significant difference between the three access techniques. Conclusion: This study confirms the safety of various access techniques used in laparoscopic procedures; however, the choice of access type should be individualized.},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - Laparoscopic Access Techniques: Experience in a Developing Country, Sudan
    AU  - Mohanned Omer Abass
    AU  - Elssayed Osman Elssayed
    AU  - Abdelrahman Babekir Mhammed
    Y1  - 2020/06/16
    PY  - 2020
    N1  - https://doi.org/10.11648/j.js.20200804.12
    DO  - 10.11648/j.js.20200804.12
    T2  - Journal of Surgery
    JF  - Journal of Surgery
    JO  - Journal of Surgery
    SP  - 109
    EP  - 113
    PB  - Science Publishing Group
    SN  - 2330-0930
    UR  - https://doi.org/10.11648/j.js.20200804.12
    AB  - Background: Minimal access surgery has revolutionized the field of surgery. Access to the abdominal cavity represents a critical step in laparoscopic procedures. Various techniques have been used to obtain safe access into the abdominal cavity, with no apparent superiority of one technique over another. Aim: This study was conducted to assess the different types of laparoscopic access techniques used at Almak Nimir University Hospital in the period from January to December 2019. Methodology: This descriptive cross-sectional study compared the use and outcomes of different laparoscopic access techniques in various laparoscopic procedures performed at Almak Nimir University Hospital, (Shendi University, Shendi, Sudan). Results: The study included 324 patients with a mean age of 26.2±15.3 years (range 1–85 years). Most of the patients were female (266 patients, 82.1%). Of the laparoscopic procedures, 77.2% were laparoscopic appendicectomy while 18.8% were laparoscopic cholecystectomy. The Veress needle technique was used in 158 patients (49.7%), the open technique was used in 97 patients (29.9%) and direct trocar insertion was used in 66 patients (20.4%). Direct trocar insertion showed a statistically shorter procedure duration (mean 2.9±0.9 min) compared to the other techniques (p=0.001). Access-related complications occurred in five patients (0.6%), but there was no statistically significant difference between the three access techniques. Conclusion: This study confirms the safety of various access techniques used in laparoscopic procedures; however, the choice of access type should be individualized.
    VL  - 8
    IS  - 4
    ER  - 

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Author Information
  • Department of Surgery, Faculty of Medicine, Shendi University, Shendi, Sudan

  • Department of Surgery, Faculty of Medicine, Shendi University, Shendi, Sudan

  • Department of Surgery, Faculty of Medicine, Shendi University, Shendi, Sudan

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