OPEN LAPAROSCOPY TO AVOID PERFORATING LES IONS

Perforating lesions occurring during the establishment of the pneumope ritoneum using the Veres needle and blind introduction of the camera t rocar are among the major complications of laparoscopic surgery. Even when all the necessary safety measures are observed and despite comple te mastery of the technique, this complication cannot be completely av oided during the blind procedure. The technique of open laparoscopy, s o-called, with the introduction of a blunt trocar under direct vision is the sole alternative available for the prevention of such injuries. The advantages of this procedure are that, with appropriate practice, it takes no longer, can be employed in all possible situations, inclu ding previous surgery, and, in particular, when assisting a surgeon wh o is in the process of gaining experience in laparoscopic surgery. Sev ere perforating injuries and their sequelae are often advanced as an a rgument against the use of laparoscopic surgical procedures. Through t he use of open laparoscopy, injuries to blood vessels and viscera can be virtually completely eliminated, and patient safety considerably im proved. On the basis of our own experience, we can unreservedly recomm end open laparoscopy as the routine approach for all laparoscopic inte rventions.