Laparoscopic entry: a literature review and analysis of techniques and complications of primary port entry.

OBJECTIVE To obtain consensus as to the optimal form of entry technique for access to the peritoneal cavity. DESIGN A meta-analysis of all relevant English language studies of laparoscopic entry complications. MAIN OUTCOME MEASURES Incidence of bowel and major vascular injuries. RESULTS Bowel injuries occur in 0.7/1,000 and major vascular injuries in 0.4/1,000. The overall incidence of major injuries at time of entry is 1.1/1,000. The direct entry technique is associated with a significantly reduced major injury incidence of 0.5/1,000, when compared to both open and Veress entry produces (1.1 and 0.9/1,000 respectively, p = 0.0005). Entry-related bowel injuries are reported more often following general surgical laparoscopies than with gynaecological procedures (p = 0.001). No such difference is seen in the incidence of vascular injuries (p = 0.987). Open entry is statistically more likely to be associated with bowel injury than either Veress needle or direct entry However, open entry appears to minimise vascular injury at time of entry. CONCLUSIONS There remains no clear evidence as to the optimal form of laparoscopic entry in the low-risk patient. However, direct entry may be an under-utilised and safe alternative to the Veress needle and open entry technique.