Open versus closed establishment of pneumoperitoneum in laparoscopic surgery

BACKGROUND: Closed laparoscopy, employing a Veress needle and blind insertion of the first trocar, is favoured by most laparoscopic surgeons. The potential danger of this technique is the occurrence of visceral or vascular injury. Establishment of pneumoperitoneum by an open technique using a blunt-tipped trocar may be a safer alternative. METHODS AND RESULTS: Retrospective review of the literature and the authors' experience was used to compare closed and open laparoscopy. Data on closed laparoscopy in 489335 patients and on open laparoscopy in 12444 patients were culled. Rates of visceral and vascular injury were respectively 0.083 and 0.075 per cent after closed laparoscopy, and 0.048 per cent and zero after open laparoscopy. Mortality rates after closed and open laparoscopy were respectively 0.003 per cent and zero. Pearson chi 2 analysis demonstrated a statistically significant difference in terms of visceral and vascular injury between closed and open laparoscopy (P = 0.002); there was no such difference for mortality rates. CONCLUSION: Open establishment of pneumoperitoneum is advocated in laparoscopic surgery because it is safer than the closed method.