Mini-invasive surgery complications: Entry

The first step in laparoscopic procedures is establishment of a working space. This is usually accomplished by insufflating carbon dioxide (CO2) into the abdominal cavity to create capnoperitoneum. The first entry into the abdominal cavity is associated with higher risk than subsequent entries. Despite considerable progress in the performance of laparoscopic procedures in humans, major complications occur in about 1 of every 1000 patients during the first entry (1), and half of these complications involve the colon. After the first entry has been achieved, additional instrument portals can be safely introduced under laparoscopic control.

Laparoscopic access can be described as open (following the performance of a mini-laparotomy), closed (no surgical access to the abdominal cavity), blind (no view of the abdominal cavity during entry), or visual (with the help of a scope inserted through the port). Additionally, the first port can be inserted into an insufflated or noninsufflated abdomen.

Several techniques, instruments, and approaches have been introduced during the last few decades to minimize entry-related injuries in both human and veterinary surgery (2,3). Nevertheless, meta-analyses and evidence-based reviews have failed to document systematic advantages of one technique over any other. Moreover, the results of such studies should be interpreted with caution because not all complications are reported, particularly minor complications, and the surgeon’s preferences and expertise influence the results. In veterinary medicine, the occurrence of entry-related injuries during either establishment of pneumoperitoneum or portal placement are very well described in textbooks (4,5), but are relatively rare in clinical trials. We are aware of one clinical trial in the field of large animal medicine that examined the safety of various trocar placement techniques and identified problems with insufflation or cannula insertion in 12 of 40 horses (6). Complications during access to the abdominal cavity have also been reported in a few clinical studies within the field of small animal medicine and include: [...]