World Journal of Laparoscopic Surgery

Register      Login

VOLUME 8 , ISSUE 3 ( September-December, 2015 ) > List of Articles


Comparison between Different Entry Techniques in Performing Pneumoperitoneum in Laparoscopic Gynecological Surgery

Mandavi Rai

Citation Information : Rai M. Comparison between Different Entry Techniques in Performing Pneumoperitoneum in Laparoscopic Gynecological Surgery. World J Lap Surg 2015; 8 (3):101-106.

DOI: 10.5005/jp-journals-10033-1257

Published Online: 01-12-2010

Copyright Statement:  Copyright © 2015; The Author(s).



The main challenge facing the laparoscopic surgery is the primary abdominal access, as it is usually a blind procedure associated with vascular and visceral injuries. Laparoscopy is a very common procedure in gynecology. Complications associated with laparoscopy are often related to entry. The life-threatening complications include injury to the bowel, bladder, major abdominal vessels, and anterior abdominalwall vessel. Other less serious complications can also occur, such as postoperative infection, subcutaneous emphysema and extraperitoneal insufflation. There is no clear consensus as to the optimal method of entry into the peritoneal cavity. It has been proved from studies that 50% of laparoscopic major complications occur prior to the commencement of the surgery. The surgeon must have adequate training and experience in laparoscopic surgery before intending to perform any procedure independently. He should be familiar with the equipment, instrument and energy source he intends to use.

Materials and methods

A Literature review was performed using PubMed, MedSpace, Springer Link and search engines like Google and Yahoo. Following search terms were used: trocar, laparoscopy, complications and pneumoperitoneum, entery technique. A total of 10,000 citations were found. Selected papers were screened for further references. Publications that featured illustrations and statistical methods of analysis are selected.


Fifty-one articles were reviewed and the the operations included in our study were diagnostic laparoscopy for infertility and abdominal pathology, ovarian cyst, total laparoscopic hysterectomy, burch operation, myomectomy. The early complications recorded in our study are abdominal wall vascular injuries, visceral injuries, bradycardia, preperitoneal insufflations. The incidence of laparoscopic entry-related injuries in gynecological operations was 6.9%. Overall, there was no evidence of advantage using any single technique in terms of preventing major complications. However, there were two advantages with direct trocar entry when compared with Veress-needle entry, in terms of avoiding extraperitoneal insufflation and failed entry.


On the basis of evidence investigated in this review, there appears to be no evidence of benefit in terms of safety of one technique over another. However, the included studies are small and cannot be used to confirm safety of any particular technique. No single technique or instrument has been proved to eliminate laparoscopic entry-associated injury. Proper evaluation of the patient, supported by good surgical skills and reasonably good knowledge of the technology of the instruments remain to be the cornerstone for safe access and success in minimal access surgery.

How to cite this article

Rai M. Comparison between Different Entry Techniques in Performing Pneumoperitoneum in Laparoscopic Gynecological Surgery. World J Lap Surg 2015;8(3):101-106.

PDF Share
  1. Complications of laparoscopy: an inquiry about closed vs open entry technique. Am J Obstet Gynecol 2004;190:634-638.
  2. Pneumoperitoneum needle and trocar injuries in laparoscopy: a survey on possible contributing factors and prevention. J Reprod Med 1990;35:485-490.
  3. Towards evidence based laparoscopic entry techniques: clinical problems and dilemma. Gynecol Endosc 1999;8:315-326.
  4. A nationwide analysis of laparoscopic complications. Obstet Gynecol 1997;89:108-112.
  5. Safety in laparoscopy. J Reprod Med 1974;13:1-5.
  6. Anatomy of the left upper quadrant for cannula insertion. J Am Assoc Gynecol Laparosc 2000;7:21-24.
  7. The relationship of the umbilicus to the aortic bifurcation: complications for laparoscopic technique. Obstet Gynecol 1992;80:48-51.
  8. Trasuterine insertion of Veress needle in laparoscopy. Obset Gynecol 1990;75:456-457.
  9. An evaluation of four tests used to ascertain Veress needle placement at closed laparoscopy. J Minim Invasive Gynecol 2005;12:153-158.
  10. Complications of first entry: a prospective laparoscopic audit. Gynaecol Endosc 1999;8:327-334.
  11. SOGC clinical practice guideline. J SOGC 2007;193:433-445.
  12. Preventing gynaecological injury. The Royal College of Obstetricians and Gynaecologist. Guideline No. 48 2007:1-10.
  13. Role of microlaparoscopy in diagnosis of peritoneal and visceral adhesions and in prevention of bowl injury associated with blind trocar insertion. Fertil Steril 2000;73:631-635.
  14. A modified instrument and method for laparoscopy. Am J Obstst Gynecol 1971;110:886-887.
  15. Major and minor injuries during creation of pneumopertoneum, a multicentre study of 12919 cases. Surg Endosc 2001;15:566-569.
  16. Mastery of endoscopic and laparoscopic surgry. 2nd ed. Philadelphia: Lippincott, Williams and Wilkins; 2005.
  17. Laparoscopy entry: a literature review and analysis of techniques and complications of primary port entry. Aust NZJ Obstet Gynaecol 2002;14:365-374.
  18. Laparoscopy and major retroperitoneal vascular injuries. Surg Endosc 1995;9:1096-1110.
  19. Shielded trocars and needles used for abdominal access during laparoscopy. Rockville MD; Department of Health and Human Services; 1996.
  20. Laparoscopic entry: techniques complications and recommendations for prevention of laparoscopic injury. Laparoscopy Hospital, India. Thi-Qar Med J 2010;4(3):62-74.
  21. Abdominal field block: a new approach via the lumbar triangle. Anaesthesia 2001;56:102426.
  22. Ultrasoundguided transversus abdominis plane block. Anaesth Inten Care 2007;35:616-617.
  23. Laparoscopic entry techniques. Cochrane database of systematic reviews no. 162, Article ID CD006583, 2008.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.