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GASLESS ACCESS
Does Insufflation Help or Hurt?
A just-published review in the February 2013 issue of the journal Minimally Invasive Therapy & Allied Technologies (tinyurl.com/a7y4aqy) assessed the roles of gasless and CO2 laparoscopy.
The authors focused on the most recent randomized or prospective controlled studies and found that gasless laparoscopy "offers some advantages eliminating the adverse effects and potential risks of CO 2 insufflations." It's also worth noting that not using gas also eliminates extraperiotoneal insufflation issues, is more comfortable for the patient and, as a result, can speed recovery and discharge to home.
According to the report, CO2 used in regular laparoscopy generated an advantageous tamponade effect on small vessels; CO2 laparoscopy also allowed for more precise myoma enucleation in myomectomy — which may translate to more precision in other procedure types as well.
— Patricia L. Turner, MD, FACS
still prefer the open primary-entry technique, use the traditional bladed Hasson trocar and cannula, and favor using the periumbilical port site, regardless of patient weight or history of peritoneal adhesions, notes the Canadian Journal of Surgery study (tinyurl.com/acf5tum). According to the survey's findings, 33% of the surgeons use Veress needle insufflation — and more than half had witnessed complications related to primary laparoscopic trocar insertion.
There are several kinds of trocars on the market: traditional/bladed,
