Safe entry during laparoscopy: a prospective audit in a district general hospital

Kevin Jones, Alfred Fan, Chris Sutton
In: Gynaecological Endoscopy · 2002 · vol. 11(2-3) , pp. 85–89 · doi:10.1046/j.1365-2508.2002.00498.x · W2162564665
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Abstract

ABSTRACT Objectives To audit the implementation of a consensus guideline on safe entry during laparoscopy. Design A prospective clinical study in a district general hospital, with a special interest in laparoscopic surgery for endometriosis. Subjects and setting All patients undergoing a gynaecological laparoscopy at The Royal Surrey County Hospital between 1 February 2000 and 31 January 2001. Surgeons completed a standard form at the time of the procedure, and these were cross‐checked with patient discharge summaries, case notes and the hospital automated records. Results At 12 months, the database included 470 patients. The Veress needle was inserted at the umbilicus in 458 (97.4%) of patients (343 at the base of the umbilicus and 115 subumbilically), and at Palmer's point in nine (1.9%), and in one patient access was gained through an open method. A suprapubic insertion was used in two patients. A gas pressure of 25 mmHg was used to establish a pneumoperitoneum in 299 patients (63.6%), and a volume technique was used in 167 patients (35.5%). All laparoscopies performed on the professional unit (C.S.) complied with the Middlesbrough guidelines. There were 23 (4.5%) complications related to the laparoscopy. Extraperitoneal insufflation occurred in 14 patients, and omental emphysema in four patients. A bowel injury occurred in two patients (0.42%), and uterine perforation in another two patients (0.42%). One procedure (0.21%) was converted to a laparotomy because of bleeding during treatment of an ectopic pregnancy. There were no vascular injuries, and no injuries occurred as a result of operative laparoscopic surgery. Conclusion Apart from laparoscopies performed on the professional unit (C.S.), a large number of procedures did not comply with the recommendations of the Middlesbrough consensus, following implementation of the consensus guidelines.

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endometriosis

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