Principles of safe laparoscopic entry

Laparoscopy is now the preferred approach for performing diagnostic procedures and therapeutic interventions in gynaecology. Minimally invasive surgery is less disabling, reduced hospital stay and more cost effective to health care systems, when compared with conventional open operations [1], [2], [3], [4], [5] and [6]. Although the risk of major complications does not significantly differ between benign gynaecological laparoscopic and conventional open procedures, laparotomy has been associated with a 40% higher risk of minor complications [6]. Most often the risk of complications during laparoscopy occurs during initial entry into the abdominal cavity. The rates of life-threatening complications at the time of abdominal entry are low – 0.4 gastrointestinal iatrogenic injuries and 0.2 major blood vessel injuries per 1000 laparoscopies [7]. However these represent approximately 50% of all serious laparoscopic complications [8] and laparoscopic medico-legal litigations (http://www.piaa.us/LaparoscopicInjuryStudy/pdf/PIAA_2000). Minor complications include extra-peritoneal insufflation, which also occurs prior to the initiation of the intended surgical procedure, and postoperative wound infection.