Optical trocar systems: laparoscopic entry and its complications (a study of cases in Germany)

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Abstract
Objectives: To assess the different techniques available for Veress needle and trocar entry under direct vision, and to evaluate the complications caused during laparoscopic entry, according to the German Gynaecological Endoscopic Complication Register.Design: A detailed description is given of the different trocar entry techniques under direct vision including use of the optical trocar cannula. The German Gynaecological Endoscopic Complication Register compares the data from 17 745 patients who underwent laparoscopic or hysteroscopic surgery at 15 different centres in 1997.Results: Complications occurred in 172 (0.86%) of 20 050 endoscopic procedures; 116 of these were laparoscopic interventions (1%), and 56 were hysteroscopic interventions (0.7%). Of the 116 laparoscopic complications, 50 (43.1%) resulted from trocar entry problems. During the last 4 years no trocar or Veress needle entry lacerations have been observed at the Department of Obstetrics and Gynaecology at Kiel.Conclusion: In any surgical procedure, including laparoscopy, complications cannot be avoided; however, trocar entry lacerations can be reduced considerably if direct visualization at entry is employed.

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