OPEN LAPAROSCOPY WITHOUT SPECIAL INSTRUMENTS OR SUTURES - COMPARISON WITH A CLOSED TECHNIQUE

An important advantage of open laparoscopy over closed techniques is t he avoidance of placing a sharp trocar blindly into the peritoneal cav ity. Although an open technique theoretically minimizes the risk of ma jor retroperitoneal vessel injury and bowel injury, most laparoscopies are performed using a closed technique. In an effort to simplify open laparoscopy, a technique was developed that can be done without speci al equipment or sutures and nearly as quickly as a closed technique. T o compare the effectiveness of this open laparoscopic technique to a c losed technique, a prospective, observational, cohort study was carrie d out on 66 women undergoing laparoscopy for either infertility or pel vic pain. The open technique was performed on 35 consecutive patients and compared to a closed technique performed on 31 patients on a diffe rent service during the same period. Evaluation included total duratio n of the procedure, length of the incision, incidence of CO2 leakage a nd complications. The open technique took slightly longer, and the inc ision was slightly longer. CO2 leakage occurred in 5 of 35 of the open cases but in none of the 31 closed cases. Leakage was controlled effe ctively in every case by application of a towel clip to the skin incis ion. No complications occurred with either technique. This study sugge sted that an open technique that requires no special equipment or sutu res may be a useful alternative approach for laparoscopy when insertio n of a sharp trocar is undesirable.