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.

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.

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