+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Laparoscopic access: complications, technologies, and techniques



Laparoscopic access: complications, technologies, and techniques



Current Opinion in Obstetrics and Gynecology 14(4): 365-374



To review laparoscopic access systems, insertion techniques, and the risks of complications associated with their use. Access devices usually comprised an external cannula and a removable sharp pyramidal trocar for penetration of the abdominal wall, and were nearly universally positioned following establishment of a pneumoperitoneum. However, it is apparent that such devices and techniques contribute to patient morbidity through visceral and vascular injury, as well as incision-related complications such as dehiscence and hernia. There exist alternative approaches to positioning insufflation needles and the initial cannula, which may reduce the incidence of vascular and visceral injury particularly in the face of previous abdominal surgery. Inserting the initial cannula after minilaparotomy is associated with a reduced risk of vascular injury, but visceral complications still occur. Some new access instruments may reduce the risk of some complications associated with 'blind entry', and although not all seem to be effective in this regard, a set of blunt-tipped devices now exist, which are surprisingly easy to position and may limit the risk of injury while significantly reducing the size of the myofascial defect in the abdominal wall. Port site metastasis is a relatively newly recognized complication of oncological surgery and is a concern, but further investigation is required to determine whether such metastasis is related to a change in clinical outcome. The incidence and spectrum of access-related complications is greater than previously perceived. Newer devices and modifications in technique may reduce the incidence of such adverse events.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 046517552

Download citation: RISBibTeXText

PMID: 12151825

DOI: 10.1097/00001703-200208000-00002


Related references

Laparoscopic entry: a review of techniques, technologies, and complications. Journal of Obstetrics and Gynaecology Canada 29(5): 433-447, 2007

Patterns and predictors of laparoscopic complications in pediatric urology: the role of ongoing surgical volume and access techniques. Journal of Urology 180(2): 681-685, 2008

Access-related complications in laparoscopic surgery. Tips and tricks to avoid trocar complications. Der Chirurg; Zeitschrift für Alle Gebiete der Operativen Medizen 73(8): 863-76; Quiz 877-9, 2002

New technologies and techniques for laparoscopic partial nephrectomy. Urologic Oncology 30(4): 353-355, 2012

Minimal access spinal technologies: state-of-the-art, indications, and techniques. Joint, Bone, Spine 71(6): 459-469, 2004

Complications of the laparoscopic access. Il Giornale di Chirurgia 17(1-2): 31-36, 1996

Endoscopic closure of gastric access in perspective NOTES: an update on techniques and technologies. Surgical Endoscopy 24(2): 298-303, 2010

Abdominal access complications in laparoscopic surgery. Journal of the American College of Surgeons 192(4): 525-536, 2001

Clinical problems and complications in laparoscopic access. Ceska Gynekologie 65(6): 464-470, 2001

Complications associated with optical-access laparoscopic trocars. Obstetrics & Gynecology 99(4): 553-555, April, 2002

Specimen processing during laparoscopic renal surgery: a review of techniques and technologies. Clinics 69(12): 862-866, 2015

Access-port complications after laparoscopic gastric banding. Obesity Surgery 13(1): 128-131, 2003

General and access-related complications of laparoscopic cholecystectomy. Buechler, M W, Frei, E, Klaiber, C, Kraehenbuel, L Progress in Surgery; Five years of laparoscopic cholecystectomy: A reappraisal 185-190, 1996

Imaging of complications associated with port access of abdominal laparoscopic surgery. Abdominal Imaging 39(2): 398-410, 2014