Inexperienced Users

The ease of use of the LapCap technique was particularly advantageous for the purposes of teaching abdominal entry to residents, fellows and attending physicians who do not have extensive experience in creating pneumoperitoneum using the Veress needle. 

In our experience of introducing the LapCap to other surgeons, initial adaptations to this new technology have been very positive even for the seasoned laparoscopist.

However, because entry with the LapCap differs from conventional practices for Veress needle insertion, there is a definite learning curve for new users. 

The sight of the abdominal wall being vacuumed into the dome is unfamiliar to new users and some expressed concerns for skin bruising, although no evidence of superficial barotrauma was noted in our experience. Our experience also revealed that new users are likely not to insert the Veress needle deeply enough in the LapCap to enter the peritoneal cavity, as these lengths seemed excessive to practitioners accustomed to inserting the needle directly into the elevated abdominal wall.  New users also tended to remove the device when the opening pressure was above 10 mmHg, even though our data show that it is likely they had achieved proper placement.  New users were also unaccustomed to insertion of the Veress needle without a prior skin incision, necessitating the third click as an auscultatory adaptation for practitioners who usually seek only two.  

New users generally responded positively to their experience with the LapCap.  Skilled laparoscopists, especially in teaching institutions, had an increased level of comfort associated with the sense of controlled entry which the LapCap creates.  Less-seasoned laparoscopists appreciated the fact that the device makes the creation of pneumoperitoneum practically “automatic”.

It is likely that new users will have to change their expectations, modeled on techniques developed prior to the advent of the LapCap, and adapt their practice to meet the parameters we have found to be associated with successful use of the device. We expect surgeons familiar with the device will reach a rate close to 100% for successful entry at first attempt even on difficult cases as we did.  In order to maximize success, we believe that surgeons should learn this technique from other practitioners who are experienced using the LapCap.

Conclusions

The LapCap is a simple device which has allowed our team to create pneumoperitoneum with ease and predictability even on obese patients or those with multiple prior surgeries.  It is, in our opinion, a novel technology which has the potential to decrease and may eliminate the risk of retroperitoneal injury associated with the use of Veress needle.  As it has the potential to avoid rare but truly disastrous complications, it deserves to be further evaluated and tested.

We believe that although experienced endoscopists may feel they don’t need this instrument (as we did), they should consider learning how to use it.  They may find it especially useful in teaching safe abdominal entry to the novice in laparoscopic surgery and enjoy the comfort of knowing they have done their best to maximize the patient’s safety.

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