Which Laparoscopic Entry Technique is the Preferred Choice?
Over the course of two decades, the debate surrounding the safest laparoscopic entry technique has remained unresolved, lacking a consensus. To address this knowledge gap, the present study aimed to provide an updated assessment of the safety of various laparoscopic entry techniques by systematically searching six electronic databases, encompassing studies from their inception up until February 2021. The study involved randomized controlled trials (RCTs) that directly compared different laparoscopic entry techniques.
The study found-
- Inclusion of 25 RCTs (6950 patients).
- Complications like vascular, visceral, and omental injury, failed entry, extraperitoneal insufflation, bleeding and infection at the trocar site bleeding, and incisional hernia.
- Significantly higher OR for Veress needle than direct trocar for omental injury, failed entry, and extraperitoneal insufflation.
- Significantly higher OR for the Veress needle than an open method for omental injury, failed entry, extraperitoneal insufflation, and incisional hernia.
- Significantly lower OR for direct trocar than the open method for visceral injury and trocar site infection.
Therefore, when it comes to laparoscopic entry techniques, the direct trocar method might be a better option compared to the Veress needle and open methods due to its lower risk of complications.
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