SAFETY AND EFFICACY OF MODIFIED OPEN TECHNIQUE AS A FIRST LAPAROSCOPIC ENTRY IN COMPARISON WITH DIRECT TROCAR ENTRY AND VERESS NEEDLE TECHNIQUE
Authors: Issam Merdan, Sadq Ghleb Kadem & Yaqoop Ayoob Yaqoop
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Issam Merdan*, Sadq Ghleb Kadem# & Yaqoop Ayoob Yaqoop@ *MB,ChB, FICMS, CABS, Professor of Surgery, Department of Surgery. College of Medicine, University of Basrah, Consultant Surgeon, Al-Sadir Teaching Hospital, #MB,ChB, FICMS, General Surgeon, Department of Surgery, Al Shiffa General Hospital, @MB,ChB, FICMS, CABS, General Surgeon, Department of Surgery, Al Shiffa General Hospital, Basrah, IRAQ.
Abstract The creation of pneumoperitoneum is an essential step in laparoscopy, Veress needle, direct trocar entrance and modified open methods with their different modifications are the three widely used methods nowadays. Each method has its own advantages & disadvantages and each surgeon has his own preferred method of creating pneumoperitoneum based on his training and experience. The aim is to compare the safety and efficacy of modified open insertion technique (MOIT) with the direct trocar insertion (DTI) and Veress needle techniques (VN). From January 2013 to December 2015, two hundred ten patients with different indications for laparoscopic surgery were included in this study for evaluation of three different methods of creating pneumoperitoneum, one hundred forty of them were operated upon in Al-Sadir teaching hospital by same laparoscopic surgeon with closed technique, this group was equally divided in to two groups; Veress needle technique (VN group) and direct trocar insertion technique (DTI group) each group included 70 patients, the remaining seventy patients were operated upon in Al Shiffa general hospital by same laparoscopic surgeons with modified open trocar insertion technique (MOTI group). Of the 210 patients; 70 (33.33%) patients operated with Veress needle (VN) technique in patients, 70 (33.33%) patients operated with Direct trocar insertion (DTI) technique and 70 (33.33%) patients operated with Modified open trocar insertion (MOTI), the patient’s ages ranged from 17 to 76 years, 172 (82%) patients were females and 38 (18%) patients were males. The mean time required for entry in patients subjected to VN technique was 3.63±0.64 minutes in comparison to 1.79±2.39 minutes and 2.01±1.82 minutes for (DTI) and (MOTI) techniques respectively, this difference is statistically significant (p-value <0.001), the VN technique associated with high rate of minor complications 32 (45.71%) patients in comparison with 7 (10%) patients and 5 (7.14%) patients reported during DTI and MOTI respectively, this difference is statistically significant (p-value <0.001), there were no reported major complication in this study like visceral or vascular injury and gas embolism. In conclusion, both DTI and MOTI techniques are safe and effective procedures to create pneumoperitoneum during laparoscopic surgery, they are associated with few minor complications and no failer rate in comparison to VN technique.