Laparoscopic Peritoneal Entry with the Reusable Threaded Visual Cannula
Presented in part at the 37 Global Congress of Minimally Invasive Gynecology, Las Vegas, Nevada, October 28–November 1, 2008, and received the Kurt Semm award for excellence in pelviscopy.
Received 2 September 2009; accepted 6 March 2010.
Abstract
Study Objective
To estimate the feasibility, reproducibility, and safety of laparoscopic port establishment using a trocarless and externally threaded visual cannula (TVC).
Design
Multicentre, prospective, observational study (Canadian Task Force classification II-2).
Setting
Three university-affiliated teaching hospitals.
Patients
Four thousand seven hundred twenty-four women (median age, 34 years; median body mass index, 25) underwent laparoscopic surgery.
Intervention
After administration of general anesthesia, the Veress needle was inserted at the umbilicus or the left upper quadrant (LUQ) using Veress intraperitoneal pressure of 10 mm Hg or less as proxy for correct placement. Transient high intraperitoneal pressure of 20 to 30 mm Hg was attained, and primary and ancillary ports were established using the reusable trocarless TVC.
Measurements and Main Results
Institutional research ethics board approval and patient consent for video capture were obtained. Primary umbilical entry was established in 4598 patients (97.33%), primary LUQ entry in 123 (2.60%), and primary suprapubic entry in 3 (0.06%) patients. Peritoneal preinsufflation was abandoned when 3 consecutive umbilical or LUQ Veress needle insertion attempts failed. Some patients at high risk with known peritoneal adhesions or previous lower abdominal midline scars did not undergo preinsufflation, and the trocarless TVC was applied directly. Surgery was postponed in 3 patients in whom insufflation failed, to enable further counseling and appropriate consenting. There were no serious abdominal wall or intraabdominal vascular injuries. One transverse colon, densely adhered to the umbilical region, was injured, which was recognized and repaired intraoperatively. Residents, fellows, or faculty recorded entry-related data on forms postoperatively for study and analysis.
Conclusions
Establishing peritoneal ports with the trocarless TVC is feasible, reproducible, and seems to be highly adoptable.
aDepartment of Obstetrics and Gynecology, Division of Gynecologic Endoscopy, St. Joseph's Health Centre, University of Toronto, Toronto Ontario, Canada
bDepartment of Obstetrics and Gynecology, St. Joseph's Health Centre, University of Western Ontario, London Ontario, Canada, Ontario, Canada
cDepartment of Obstetrics and Gynecology, King Saud University, Riyadh, Saudi Arabia
Corresponding author: Artin M. Ternamian, MD, Associate Professor, Department of Obstetrics and Gynecology, University of Toronto, 77 Truman Rd, Toronto, ON, M2L 2L7 Canada.
The authors have no commercial, proprietary, or financial interest in the products or companies described in this article.
Dr. Ternamian invented the trocarless Threaded Visual Cannula, is a consultant for Karl Storz Endoscopy, and holds some proprietary interest in the product described in this article.
ABSTRACT