In an effort to minimize injuries associated with closed laparoscopic entry, many surgeons use a 10-mm standard open laparoscopy technique. Disadvantages of this open technique are that it requires a larger incision, fascial sutures, and does not always achieve an airtight seal. Although 5-mm laparoscopics with excellent optics are available, little has been written about open techniques using them.
We report a modified 5-mm open laparoscopy technique without fascial sutures. The fascia is elevated with small Kocher forceps and incised in the midline. The peritoneum is bluntly perforated with a hemostat-directed cephalad, and a blunt trocar with a sleeve is inserted in this direction. After rotating the sleeve toward the pelvis, a 5-mm laparoscope is placed into the abdomen before insufflation.
We have performed approximately 350 laparoscopies with only one major complication of a perforated transverse colon densely adherent beneath the umbilicus in a woman without previous abdominal surgery. Minor carbon dioxide leakage was uncommon and no wound infections or hernias occurred.
This 5-mm modified open laparoscopic entry technique minimizes some of the disadvantages associated with conventional open and closed 10-mm laparoscopic techniques while avoiding blind placement of sharp instruments into the peritoneal cavity.
A 5-mm modified open laparoscopic entry technique minimizes the disadvantages of conventional 10-mm open techniques while avoiding blind placement of sharp instruments.
Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina.
Corresponding author: William W. Hurd, MD, MPH, 5704 Fayetteville Road, Durham, NC 27713-9089; e-mail: email@example.com.
Financial Disclosure The authors did not report any potential conflicts of interest.
The authors thank Sharon Teal (Sharon Teal, Inc., Indianapolis, Indiana) for the illustrations.
Dr. Hurd, Associate Editor of Obstetrics & Gynecology, was not involved in the review or decision to publish this article.