ROUTINE USE OF OPEN TECHNIQUE IN LAPAROSCOPIC OPERATIONS

BACKGROUND: The ''blind'' insertion of the Veress needle for insufflat ion of the peritoneal cavity with subsequent closed placement of the f irst trocar during laparoscopic abdominal procedures can result in sev ere major vascular and visceral injuries. An open technique was propos ed as an alternative method for insufflation in patients with abdomina l scars to reduce the possibility of such complications. The aim of th is article is to report the results of our experience with the routine use of open technique in laparoscopic surgery. STUDY DESIGN: Open tec hnique was routinely used and prospectively evaluated in 330 patients who underwent laparoscopic procedures. RESULTS: Laparoscopic conversio n was necessary in 25 out of 330 cases (7.6 percent): in 20 cases for unclear biliary anatomy during laparoscopic cholecystectomy, and in 5 cases for minor hemorrhage that could not be managed by laparoscopy, i n the 305 procedures completed by laparoscopy, 11 patients (3.6 percen t) had 13 postoperative complications. These complications were all of minor importance and were always unrelated to trocar insertion; in pa rticular, no major vascular or visceral injuries were observed. CONCLU SIONS: Routine use of open technique for pneumoperitoneum represents t he best prevention of most of the severe trocar-related complications that are potentially avoidable.