RISKS OF BLIND VERSUS OPEN APPROACH TO CELIOTOMY FOR LAPAROSCOPIC SURGERY

Patients undergoing laparoscopic cholecystectomy had celiotomy either by a blind (Veress needle) approach (n = 781) or by fascial and perito neal incision with insertion of a 10-mm sheath under direct vision (n = 247). The blind approach was associated with three small bowel injur ies and one tear of the left common iliac artery. No intestinal or vas cular injuries occurred in the open insertion group. The difference wa s not statistically significant. The mean duration of surgery was 81.4 +/- 1.3 min in the blind group compared with 72.6 +/- 2.0 min in the open group (p < 0.001). There was no significant difference in postope rative stay or in return to normal activity between the two groups. It is recommended that blind access to the peritoneal cavity for laparos copy be abandoned in favor of an open approach because the blind appro ach confers no advantages and places the patient at risk for unrecogni zed visceral or vascular injury even though these injuries may not occ ur at a statistically significant frequency.