et al - Primo accesso in chirurgia laparoscopica Primo accesso in chirurgia laParoscoPica

Abstract

The peritoneal access remains the gravest concern for the laparoscopic surgeon and continues to be a leading cause of complication during laparoscopic surgery. Choosing the best method of peritoneal access depends on the patient’s phenotype and clinical history. Since no single methods is completely adaptable for all patients, the surgeon must be knowledgeable about alternative methods and be able to execute them technically. The aim of the manuscript is to provide clinical direction on laparoscopic entry techniques and technologies and their associated complications. The laparoscopic surgeon must be mindful that most life-threatening surgical accidents to the bowel as well as to retroperitoneal vessels occur during insertion of the Veress needle and primary cannula. We analize the different laparoscopic entry techniques and technologies including the classic pneumoperitoneum (Veress/trocar), the open (Hasson), the direct trocar insertion, the use of disposable shielded trocars, radially expanding trocars, and visual entry systems. Key words