Laparoscopy entry in patients with previous abdominal and pelvic surgery

Surg Innov. 2011 Sep;18(3):201-5. doi: 10.1177/1553350610393989. Epub 2011 Jan 18.


Background: The background of this investigation is based on a common surgical problem: The access in laparoscopic surgery is more difficult in women with previous abdominopelvic surgery, since adhesions and viscera could be close to the point of trocar insertion.

Purpose: The authors analyzed the safety and the efficacy of a modified direct optical entry (DOE) method versus the Hasson's method by open laparoscopy (OL) in women with previous abdominopelvic surgery in a preliminary prospective case-control study.

Materials and methods: A total of 168 women underwent laparoscopic surgery in university-affiliated hospitals: 86 were assigned to abdominal DOE (group A) and 82 to OL (group B). The main outcome measures were statistically compared: time required for entry into abdomen, blood loss, and occurrence of vascular and/or bowel injury. All patients had an intraperitoneal view of the primary port site during surgical procedure.

Results: Statistical differences, in favor of the DOE group (P < .01), were found in duration of entry and blood loss. The vascular and bowel injuries in OL versus DOE were not statistically different.

Conclusions: Obtaining access to the peritoneal cavity in laparoscopic surgery is more difficult in patients with previous abdominopelvic surgery, since it can become a difficult, time-consuming, and occasionally hazardous procedure. The study results suggest that DOE is advantageous when compared with OL in terms of saving time enabling a safe and expeditious visually guided entry for laparoscopy.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Abdomen / surgery*
  • Adult
  • Analysis of Variance
  • Antibiotic Prophylaxis
  • Case-Control Studies
  • Chi-Square Distribution
  • Female
  • Gynecologic Surgical Procedures / methods*
  • Humans
  • Laparoscopy / methods*
  • Pelvis / surgery*
  • Postoperative Complications / prevention & control*
  • Prospective Studies
  • Reoperation
  • Tissue Adhesions / complications*