Previous Abdominal Surgery and Closed Entry for Gynecologic Laparoscopy: A Prospective Study

All gynecologic laparoscopic procedures performed at the authors' institution in the 12-month period from January 2000 to January 2001 were entered into a comparison trial of complications from laparoscopy in women with no prior abdominal surgery (group I, n = 368) and women with a history of previous abdominal surgery (group II, n = 109). Standard laparoscopic techniques were used for all procedures. In group I, the initial insertion of the Verres needle was made in the umbilicus. After 2 unsuccessful attempts, the location of the Verres needle placement was changed to the right upper quadrant. In group II, the initial insertion of the Verres needle was in the left upper quadrant 2 to 3 cm inferior to the middle of the last rib. After 2 unsuccessful attempts, the procedure was converted to open laparoscopy. There were no complications in group I. All complications, both major, which were defined as vascular or visceral injuries, and minor, defined as failure or unsatisfactory achievement of pneumoperitoneum, occurred in women who had undergone previous abdominal surgery. The only major complication was a bowel injury, which was associated with insertion of the Verres needle. It was repaired laparoscopically. Minor injuries included 13 (12%) failures to create the pneumoperitoneum, 17 (16%) subperitoneum insufflations, 12 (11%) emphysemas of the omentum, and 2 (1.8%) subperitoneal insertions of the umbilical laparoscopic trocar. In 19% of cases, several attempts at insertion of the Verres needle were necessary. In all, there were 2 attempts at insertion in 11%, 3 in 5%, and 4 in 1%.