Authors' objectives:

The majority of complications associated with laparoscopy occur during peritoneal access and the establishment of pneumoperitoneum. There are two forms of access open and closed. Open laparoscopy is usually undertaken via an Hasson-type approach. Closed laparoscopy can occur using a blind approach, with either pre-insufflation before laparoscope insertion (needle/trocar method) or insufflation after laparoscope insertion (direct trocar method). One other hybrid form of closed laparoscopy involves limited visual access through the use of an optical trocar or needle.

There has been considerable debate as to which of these access methods is the safest and/or most effective. The objective of this systematic review was to inform this debate by testing the following three hypotheses:

1. open access is safer and/or more effective than closed access

2. the hybrid visual/closed access method is safer and/or more effective than the blind/closed methods

3. the direct trocar technique is safer and/or more effective than the Veress needle/primary trocar technique.

Authors' recommendations: On the basis of the evidence presented in this systematic review, the ASERNIP-S Review Group agreed on the following classifications and recommendations concerning the safety and efficacy of access methods for establishing pneumoperitoneum. Open laparoscopy via an Hasson-type approach: Evidence Rating - The evidence-base was considered to be of average strength, quality, precision and magnitude. Safety and Efficacy - Definitive differences in the safety and efficacy of open laparoscopic access, relative to needle/trocar access, were not demonstrated. Needle/trocar laparoscopy: Evidence Rating - The evidence-base was considered to be of average strength, quality, precision and magnitude. Safety and Efficacy - Definitive differences in the safety and efficacy of needle/trocar access, relative to open access or direct trocar access, were not demonstrated. Direct trocar access: Evidence rating - The evidence-base was considered to be of average strength, quality, precision and magnitude. Safety and Efficacy - Definitive differences in the safety and efficacy of direct trocar access, relative to needle/trocar access, were not demonstrated. Optical trocar access: Evidence rating - The evidence-base was considered to be of poor strength, quality, precision and magnitude. Safety and Efficacy - Definitive differences in the safety and efficacy of optical trocar access, relative to needle/trocar access, could not be ascertained.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.surgeons.org/asernip-s/

Year Published: 2001

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Australian Safety and Efficacy Register of New Interventional Procedures-Surgical

Contact Address: ASERNIP-S 24 King William Street, Kent Town SA 5067 Australia Tel: +61 8 8219 0900

Contact Name: racs.asernip@surgeons.org

Contact Email: racs.asernip@surgeons.org

Copyright: Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S)