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Laparoscopic entry techniques: Which should you prefer?

BACKGROUND: Despite a debate spanning two decades, no consensus has been achieved about the safest laparoscopic entry technique. OBJECTIVES: To update the evidence about the safety of the main different laparoscopic entry techniques. SEARCH STRATEGY: Six electronic databases were searched from incep...

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Autores principales: Raimondo, Diego, Raffone, Antonio, Travaglino, Antonio, Ferla, Stefano, Maletta, Manuela, Rovero, Giulia, Renzulli, Federica, de Laurentiis, Umberto, Borghese, Giulia, Ambrosio, Marco, Salucci, Paolo, Casadio, Paolo, Mollo, Antonio, Seracchioli, Renato
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10087714/
https://www.ncbi.nlm.nih.gov/pubmed/35980870
http://dx.doi.org/10.1002/ijgo.14412
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author Raimondo, Diego
Raffone, Antonio
Travaglino, Antonio
Ferla, Stefano
Maletta, Manuela
Rovero, Giulia
Renzulli, Federica
de Laurentiis, Umberto
Borghese, Giulia
Ambrosio, Marco
Salucci, Paolo
Casadio, Paolo
Mollo, Antonio
Seracchioli, Renato
author_facet Raimondo, Diego
Raffone, Antonio
Travaglino, Antonio
Ferla, Stefano
Maletta, Manuela
Rovero, Giulia
Renzulli, Federica
de Laurentiis, Umberto
Borghese, Giulia
Ambrosio, Marco
Salucci, Paolo
Casadio, Paolo
Mollo, Antonio
Seracchioli, Renato
author_sort Raimondo, Diego
collection PubMed
description BACKGROUND: Despite a debate spanning two decades, no consensus has been achieved about the safest laparoscopic entry technique. OBJECTIVES: To update the evidence about the safety of the main different laparoscopic entry techniques. SEARCH STRATEGY: Six electronic databases were searched from inception to February 2021. SELECTION CRITERIA: All randomized controlled trials (RCTs) comparing different laparoscopic entry techniques were included. DATA COLLECTION AND ANALYSIS: Entry‐related complications and total time for entry were compared among the different methods of entry calculating pooled odds ratios (ORs) and mean differences, with 95% confidence intervals (CIs); P < 0.05 was considered significant. MAIN RESULTS: In total, 25 RCTs (6950 patients) were included. Complications considered were vascular, visceral and omental injury, failed entry, extraperitoneal insufflation, bleeding and infection at the trocar site bleeding, and incisional hernia. Compared to direct trocar, the OR for Veress needle was significantly higher for omental injury (OR 3.65, P < 0.001), for failed entry (OR 4.19, P < 0.001), and for extraperitoneal insufflation (OR 5.29, P < 0.001). Compared to the open method, the OR for Veress needle was significantly higher for omental injury (OR 4.93, P = 0.001), for failed entry (OR 2.99, P < 0.001), for extraperitoneal insufflation (OR 4.77; P = 0.04), and for incisional hernia. Compared to the open method, the OR for direct trocar was significantly lower for visceral injury (OR 0.17, P = 0.002) and for trocar site infection (OR 0.27, P = 0.001). CONCLUSIONS: The direct trocar method may be preferred over Veress needle and open methods as a laparoscopic entry technique since it appears associated to a lower risk of complications.
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spelling pubmed-100877142023-04-12 Laparoscopic entry techniques: Which should you prefer? Raimondo, Diego Raffone, Antonio Travaglino, Antonio Ferla, Stefano Maletta, Manuela Rovero, Giulia Renzulli, Federica de Laurentiis, Umberto Borghese, Giulia Ambrosio, Marco Salucci, Paolo Casadio, Paolo Mollo, Antonio Seracchioli, Renato Int J Gynaecol Obstet Review Articles BACKGROUND: Despite a debate spanning two decades, no consensus has been achieved about the safest laparoscopic entry technique. OBJECTIVES: To update the evidence about the safety of the main different laparoscopic entry techniques. SEARCH STRATEGY: Six electronic databases were searched from inception to February 2021. SELECTION CRITERIA: All randomized controlled trials (RCTs) comparing different laparoscopic entry techniques were included. DATA COLLECTION AND ANALYSIS: Entry‐related complications and total time for entry were compared among the different methods of entry calculating pooled odds ratios (ORs) and mean differences, with 95% confidence intervals (CIs); P < 0.05 was considered significant. MAIN RESULTS: In total, 25 RCTs (6950 patients) were included. Complications considered were vascular, visceral and omental injury, failed entry, extraperitoneal insufflation, bleeding and infection at the trocar site bleeding, and incisional hernia. Compared to direct trocar, the OR for Veress needle was significantly higher for omental injury (OR 3.65, P < 0.001), for failed entry (OR 4.19, P < 0.001), and for extraperitoneal insufflation (OR 5.29, P < 0.001). Compared to the open method, the OR for Veress needle was significantly higher for omental injury (OR 4.93, P = 0.001), for failed entry (OR 2.99, P < 0.001), for extraperitoneal insufflation (OR 4.77; P = 0.04), and for incisional hernia. Compared to the open method, the OR for direct trocar was significantly lower for visceral injury (OR 0.17, P = 0.002) and for trocar site infection (OR 0.27, P = 0.001). CONCLUSIONS: The direct trocar method may be preferred over Veress needle and open methods as a laparoscopic entry technique since it appears associated to a lower risk of complications. John Wiley and Sons Inc. 2022-09-01 2023-03 /pmc/articles/PMC10087714/ /pubmed/35980870 http://dx.doi.org/10.1002/ijgo.14412 Text en © 2022 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Articles
Raimondo, Diego
Raffone, Antonio
Travaglino, Antonio
Ferla, Stefano
Maletta, Manuela
Rovero, Giulia
Renzulli, Federica
de Laurentiis, Umberto
Borghese, Giulia
Ambrosio, Marco
Salucci, Paolo
Casadio, Paolo
Mollo, Antonio
Seracchioli, Renato
Laparoscopic entry techniques: Which should you prefer?
title Laparoscopic entry techniques: Which should you prefer?
title_full Laparoscopic entry techniques: Which should you prefer?
title_fullStr Laparoscopic entry techniques: Which should you prefer?
title_full_unstemmed Laparoscopic entry techniques: Which should you prefer?
title_short Laparoscopic entry techniques: Which should you prefer?
title_sort laparoscopic entry techniques: which should you prefer?
topic Review Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10087714/
https://www.ncbi.nlm.nih.gov/pubmed/35980870
http://dx.doi.org/10.1002/ijgo.14412
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