No single technique is superior at preventing major vascular or visceral complications during laparoscopic entry, according to a Cochrane review, but certain techniques confer advantages.
Twenty-eight randomized controlled trials, with nearly 5,000 individuals undergoing laparoscopy, were included in the review. Studies were eligible for inclusion if they compared one laparoscopic entry technique with another. Three authors independently extracted and analyzed data. A fourth author resolved differences of opinion.
Authors concluded that:
-"An open-entry technique is associated with a significant reduction in failed entry when compared to a closed-entry technique, with no difference in the incidence of visceral or vascular injury.
-"Significant benefits were noted with the use of a direct-entry technique when compared to the Veress Needle. The use of the Veress Needle was associated with an increased incidence of failed entry, extraperitoneal insufflation and omental injury; direct-trocar entry is therefore a safer closed-entry technique."
Authors noted that the low rate of complications associated with laparoscopic entry, and a small number of participants in each individual study could account for the lack of significant difference in adverse effects between techniques.
