How to improve laparoscopic access safety: ENDOTIP

To improve laparoscopic port safety, an observational study was conducted w here tissue dynamics at port-site, during use of conventional push-through trocars, were analysed. Specific performance shaping factors (PSF) were ide ntified that individually and collectively infer added risk to port creatio n. Having determined weaknesses of closed and open laparoscopic port insert ion, a new interactive visual cannula insertion and removal system is prese nted and ergonomic instrument designed. This second generation access syste m avoids the identified PSFs and can anticipate danger. Error is recognised and corrected before patient harm occurs. With renewed interest in the US Congress to curb incidence of inadvertent medical error, endoscopists shoul d revisit the fundamental first steps of laparoscopy, when more than half o f all serious complications occur. Our culture of 'blaming the human' must evolve into a culture of safety and transparency, as inadvertent laparoscop ic error is now less tolerated. Evidently, most serious laparoscopic access injuries are generally a system problem, and less of a surgeon or instrume nt issue.