Minioptics make laparoscopic surgery safer

SummaryUp until now access to the abdominal cavity in laparoscopy has been by two blind punctures: by the cannula for insufflation and by the trocar for the optic. This brings risks of bowel injury, bleeding and gas embolization. Visually controlled access to the abdominal cavity has been attempted in the past, but has never fulfilled the requirement of permanent visual control of abdominal wall penetration prior to establishment of pneumoperitoneum. We have designed a 2 mm fibre glass optic, 250 mm in length, that is inserted in a suitable cannula. The construction allows rinsing through the cannula to clear the vision and to open spaces in the puncture track by water dissection. After incision of the skin all layers of the abdominal wall can be visualized, even blood vessels and internal surfaces. Once the abdominal cavity is reached, the needle tip is turned blunt and a two-step dilation allows the surgeon to introduce the trocar via the puncture track and begin insufflation. We report the use of this fibre optic equipped safety needle in 152 laparoscopic surgical procedures. Two punctures of intestines were diagnosed and corrected immediately: they caused no complication and the intended procedure was completed laparoscopically. Laparoscopic access to the abdominal cavity was safer with this device and, as all the abdominal tissues and layers, including peritoneum, could be recognized prior to insufflation, the risk of intra-abdominal adhesions was significantly reduced.