Reduction of cannula-related laparoscopic complications using a radially expanding access device.

STUDY OBJECTIVE

To determine the safety of a new radially expanding access device compared with complication rates associated with sharp laparoscopic cannulas.

DESIGN

Prospective, multicenter study (Canadian Task Force classification II-1).

SETTING

Free-standing and hospital-based ambulatory surgery centers.

PATIENTS

Two hundred twelve women undergoing various laparoscopic procedures and followed over 44 months.

INTERVENTION

Five hundred forty-one radially dilating access devices were used exclusively for laparoscopic abdominal wall access.

MEASUREMENTS AND MAIN RESULTS

No major vascular injury, abdominal wall bleeding, intestinal injury, bladder or ureteral injury, liver trauma, or postoperative incisional hernia occurred. One patient developed a postoperative mesenteric hematoma probably caused by a venous injury from the Veress needle. Of the 541 radially expanding access cannulas placed, only 6 (1%) slipped, despite absence of fascial anchoring devices.

CONCLUSION

Radially dilating abdominal access devices may reduce laparoscopic complications, lessen a surgeon's exposure to liability, and improve patient outcomes while reducing facility costs. (J Am Assoc Gynecol Laparosc 6(1):79-84, 1999)