Laparoscopy entry in patients with previous abdominal and pelvic surgery.

BACKGROUND

The background of this investigation is based on a common surgical problem: The access in laparoscopic surgery is more difficult in women with previous abdominopelvic surgery, since adhesions and viscera could be close to the point of trocar insertion.

PURPOSE

The authors analyzed the safety and the efficacy of a modified direct optical entry (DOE) method versus the Hasson's method by open laparoscopy (OL) in women with previous abdominopelvic surgery in a preliminary prospective case-control study.

MATERIALS AND METHODS

A total of 168 women underwent laparoscopic surgery in university-affiliated hospitals: 86 were assigned to abdominal DOE (group A) and 82 to OL (group B). The main outcome measures were statistically compared: time required for entry into abdomen, blood loss, and occurrence of vascular and/or bowel injury. All patients had an intraperitoneal view of the primary port site during surgical procedure.

RESULTS

Statistical differences, in favor of the DOE group (P < .01), were found in duration of entry and blood loss. The vascular and bowel injuries in OL versus DOE were not statistically different.

CONCLUSIONS

Obtaining access to the peritoneal cavity in laparoscopic surgery is more difficult in patients with previous abdominopelvic surgery, since it can become a difficult, time-consuming, and occasionally hazardous procedure. The study results suggest that DOE is advantageous when compared with OL in terms of saving time enabling a safe and expeditious visually guided entry for laparoscopy.