Minilaparoscopy to reduce complications from cannula insertion in patientswith previous pelvic or abdominal surgery

Study Objective. To evaluate the safety and efficacy of minilaparoscopy for visualization and adhesiolysis of intraabdominal adhesions for sale insert ion of a primary umbilical cannula in patients who had previous pelvic or a bdominal surgery Design, Prospective, observational study (Canadian Task Force classificatio n II-I). Setting. University-affiliated hospital. Patients. Twenty women who had previous pelvic or abdominal surgery, exclud ing tubal ligation and simple appendectomy. Intervention. Minilaparoscopy was carried for visualization and adhesiolysi s at the entry site before insertion of an umbilical cannula. Measurements and Results. Eleven patients had Pfannenstiel scars and nine h ad vertical midline scars from previous surgeries (4 total abdominal hyster ectomies, 13 adnexal surgery, cesarean sections, 3 ectopic pregnancies, 1 r uptured appendix, 1 unknown Dowel surgery). Thirteen women (65%) had had on e previous surgery, five (25%) had had two, and two (10%) had had three. Ni ne patients (45%) had significant adhesions of omentum or intestine that re quired adhesiolysis. Mean operating time for minilaparoscopy was 5 minutes for 7 1 women who had no or minimal adhesions that did not interfere with s afe insertion of the umbilical cannula and effective use of a 10-mm telesco pe, and 25 minutes in 9 patients who required adhesiolysis before insertion of the umbilical cannula because of dense adhesions of omentum or intestin e at the entry site. No complications with minilaparoscopy occurred. Conclusion. Minilaparoscopy can be performed safely and effectively to redu ce serious vascular or visceral injury from insertion of primary cannula in patients who had previous pelvic and/or abdominal surgery. However, conclu sions cannot be derived from this study due to the small number of subjects . Further study is necessary in a larger patient population to evaluate eff icacy, safety and advantages of minilaparoscopy over of her techniques.