Laparoscopic entry techniques: What is the controversy?

OBJECTIVE: To review reported complications related to the different laparoscopic entry techniques in the human and veterinary literature and describe the benefits and limitations of each technique. STUDY DESIGN: Literature review of 57 peer-reviewed articles. METHODS: An electronic database search identified human and veterinary literature describing complications related to entry technique during laparoscopy. RESULTS: Open- and closed-entry techniques may result in trauma of abdominal organs or vasculature. During laparoscopy in man, injury to bowel and major vasculature is reported in 0.02% and 0.04% of procedures with open- or closed-entry techniques, respectively. Designs of Veress needles and trocar cannula assemblies have been developed to improve ease and safety. Early complications, defined as those observed at the time of port entry into the abdominal cavity, result from the puncture of a blood vessel leading to substantial visible hemorrhage. Late complications are detected 24 or 48 hours after surgery and result from the puncture of a loop of intestine that was not detected at the time of initial surgery. The major reasons for iatrogenic trauma in man are related to anatomical factors and the presence of adhesions. No explanation for cause of complications was identified for animals. CONCLUSION: There is no consensus in the human or veterinary literature about the best entry technique for laparoscopy. The rate of complications related to entry technique in small animals is not known because the data are underreported. CLINICAL SIGNIFICANCE: Complications related to entry techniques are expected in both man and animals. Improvements in techniques and equipment design are being developed to minimize risk.