Laparoscopic Abdominal Access and Prevention of Injury

Approximately 1 in every 1000 patients undergoing laparoscopic abdominal surgery will experience bowel or vessel perforation injury by trocars during initial access.1 A systematic review of studies found no conclusive evidence that any one method of gaining initial access and establishing pneumoperitoneum during laparoscopic surgery is safer or more efficacious than another.2 While injuries occurred with all commonly used methods, trends in the findings warrant further study. Similarly, reports reviewing injury claims submitted to the Food and Drug Administration as well as to insurers found that no single trocar is without the potential for injury.3,4 While neither the method nor type of trocar used appears to influence the safety of establishing laparoscopic access, factors reported to contribute significantly to visceral and vascular injuries are usage errors,4 inexperience,5 poor skill,6 violation of good technique,6 high axial force with excessive downward displacement of the abdominal wall,6,7 over-thrust,6 inadequate incision size,6 and previous abdominal surgery.7 Although infrequent, injuries and complications related to abdominal access for laparoscopic surgery concern surgeons, as they adversely affect patients and may lead to litigation.3,4 After a review of the trocars available for laparoscopic surgery, common injuries and key issues in injury prevention will be addressed. SECTION I