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Gepubliceerd in:
2024 | OriginalPaper | Hoofdstuk
16. Access to the abdominal cavity
Auteurs : Prof. Eduardo M. Targarona, Sonia Fernández Ananín, MD, PhD, Jesús Bollo, MD, PhD
Gepubliceerd in: The Technical Principles of Endoscopic Surgery
Uitgeverij: Bohn Stafleu van Loghum
Abstract
Laparoscopic surgery, by definition, implies working inside a virtual natural cavity, which becomes real after the creation of a pneumoperitoneum. There are three technical approaches:
The surgeon should know the technical details, advantages, and potential complications of each method. There are several situations in which the surgeon should be aware of the increased difficulty of establish the pneumoperitoneum, such as, pregnancy, liver cirrhosis, and hostile abdomen (previous surgery). There is a lack of evidence on this topic. What has been proven is the advantage of direct optical trocar entry over the Veress needle technique, with a higher initial successful entry with the optical trocar.
1
Closed access with Veress needle; this is the oldest and most traditional access to create the pneumoperitoneum for laparoscopic entry.
2
The direct vision technique, or optical access technique. This is a quick and safe alternative that requires accessing the abdominal cavity using a specialized trocar with a transparent tip, which allows how the abdominal wall is traversed to be visualized.
3
The open-access technique, developed in 1971 by Hasson.