A prospective multicentre study of laparoscopic complications related to the direct‐entry technique

Abstract

ABSTRACT Objective ‘Direct entry’ is a laparoscopic entry technique which involves the insertion of a trocar directly into the abdominal cavity without a prior pneumoperitoneum. The objective of this study was to evaluate the major complication profile of this relatively uncommon entry technique in consecutive patients undergoing diagnostic or operative laparoscopy. Design Over a period of 3 years, 1838 consecutive patients were recruited from the practice of two experienced gynaecological endoscopists. Complications directly related to the entry technique which occurred intraoperatively, either immediately or up to 2 weeks postoperatively, were recorded prospectively. Complications were considered to be events which significantly prolonged or altered the planned procedure, delayed discharge or led to a prolongation of convalescence. Results Only one major injury occurred, a perforation of the large bowel, which was diagnosed immediately and managed laparoscopically with no long‐term sequelae. Conclusion When compared with other laparoscopic entry techniques, direct entry is a safe, cheap, effective and underutilized modality for entering the peritoneal cavity in ‘low‐risk’ patients.