Cochrane · systematic review · CD006583
Laparoscopic entry techniques
Ahmad, G, Baker, J, Finnerty, J, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
30
current version
GRADE rated
15
No studies
11
Included studies
NR
No studies 11 · 36.7%Ungraded 4 · 13.3%Very low 14 · 46.7%Low 0 · 0%Moderate 1 · 3.3%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyOpen‐entry vs closed‐entry technique for patients undergoing laparoscopy
Population: patients undergoing laparoscopy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Open‐entry vs closed‐entry technique | no estimate extracted | 2 studies · 715 participants | Ungraded |
Vascular injury (major vessels and abdominal wall vessels) Open‐entry vs closed‐entry technique | Peto OR 0.14 [0, 6.82] | 4 studies · 915 participants | Very low Downgraded: risk of bias, imprecision |
Visceral injury (bladder or bowel) Open‐entry vs closed‐entry technique | Peto OR 0.61 [0.06, 6.08] | 4 studies · 915 participants | Very low Downgraded: risk of bias, imprecision |
Gas embolism Open‐entry vs closed‐entry technique | no estimate extracted | NR | No studies |
Solid organ injury Open‐entry vs closed‐entry technique | no estimate extracted | NR | No studies |
Failed entry Open‐entry vs closed‐entry technique | Peto OR 0.45 [0.14, 1.42] | 3 studies · 865 participants | Very low Downgraded: risk of bias |
Direct trocar entry vs Veress needle entry for patients undergoing laparoscopy
Population: patients undergoing laparoscopic surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Direct trocar entry vs Veress needle entry | no estimate extracted | 4 studies · 1438 participants | Ungraded |
Vascular injury (major vessels and abdominal wall vessels) Direct trocar entry vs Veress needle entry | Peto OR 0.59 [0.18, 1.96] | 6 studies · 1603 participants | Very low Downgraded: risk of bias, imprecision |
Visceral injury (bladder or bowel) Direct trocar entry vs Veress needle entry | Peto OR 2.02 [0.21, 19.42] | 5 studies · 1519 participants | Very low Downgraded: risk of bias, imprecision |
Gas embolism Direct trocar entry vs Veress needle entry | no estimate extracted | 2 studies · 810 participants | Ungraded |
Solid organ injury Direct trocar entry vs Veress needle entry | Peto OR 0.58 [0.06, 5.65] | 3 studies · 1079 participants | Very low Downgraded: risk of bias, imprecision |
Failed entry Direct trocar entry vs Veress needle entry | Peto OR 0.24 [0.17, 0.34] | 8 studies · 3185 participants | Moderate Downgraded: risk of bias, imprecision |
Direct vision entry vs Veress needle entry for patients undergoing laparoscopy
Population: patients undergoing laparoscopy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Direct vision entry vs Veress needle entry | no estimate extracted | NR | No studies |
Vascular injury (major vessels and abdominal wall vessels) Direct vision entry vs Veress needle entry | Peto OR 0.39 [0.05, 2.85] | 1 study · 186 participants | Very low Downgraded: risk of bias, imprecision |
Visceral injury (bladder or bowel) Direct vision entry vs Veress needle entry | Peto OR 0.15 [0.01, 2.34] | 2 studies · 380 participants | Very low Downgraded: risk of bias, imprecision |
Gas embolism Direct vision entry vs Veress needle entry | no estimate extracted | NR | No studies |
Solid organ injury Direct vision entry vs Veress needle entry | no estimate extracted | NR | No studies |
Failed entry Direct vision entry vs Veress needle entry | no estimate extracted | NR | No studies |
Direct vision entry vs open‐entry technique for patients undergoing laparoscopy
Population: patients undergoing laparoscopy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Direct vision entry vs open‐entry technique | no estimate extracted | NR | No studies |
Vascular injury (major vessels and abdominal wall vessels) Direct vision entry vs open‐entry technique | no estimate extracted | 2 studies · 392 participants | Ungraded |
Visceral injury (bladder or bowel) Direct vision entry vs open‐entry technique | Peto OR 0.13 [0, 6.5] | 2 studies · 392 participants | Very low Downgraded: risk of bias, imprecision |
Gas embolism Direct vision entry vs open‐entry technique | no estimate extracted | NR | No studies |
Solid organ injury Direct vision entry vs open‐entry technique | Peto OR 6.16 [0.12, 316.67] | 1 study · 60 participants | Very low Downgraded: risk of bias, imprecision |
Failed entry Direct vision entry vs open‐entry technique | Peto OR 0.4 [0.04, 4.09] | 1 study · 60 participants | Very low Downgraded: risk of bias, imprecision |
Radially expanding (STEP) trocars for primary port entry vs standard (non‐expanding) trocars for patients undergoing laparoscopy
Population: patients undergoing laparoscopy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality Radially expanding (STEP) trocars for primary port entry vs standard (non‐expanding) trocars | no estimate extracted | NR | No studies |
Vascular injury (major vessels and abdominal wall vessels) Radially expanding (STEP) trocars for primary port entry vs standard (non‐expanding) trocars | Peto OR 0.24 [0.05, 1.21] | 2 studies · 331 participants | Very low Downgraded: risk of bias, imprecision |
Visceral injury (bladder or bowel) Radially expanding (STEP) trocars for primary port entry vs standard (non‐expanding) trocars | Peto OR 0.13 [0, 6.37] | 2 studies · 331 participants | Very low Downgraded: risk of bias, imprecision |
Gas embolism Radially expanding (STEP) trocars for primary port entry vs standard (non‐expanding) trocars | no estimate extracted | NR | No studies |
Solid organ injury Radially expanding (STEP) trocars for primary port entry vs standard (non‐expanding) trocars | Peto OR 1.05 [0.07, 16.91] | 1 study · 244 participants | Very low Downgraded: risk of bias, imprecision |
Failed entry Radially expanding (STEP) trocars for primary port entry vs standard (non‐expanding) trocars | no estimate extracted | NR | No studies |
Open‐entry compared to closed‐entry for patients undergoing laparoscopy
Population: patients undergoing laparoscopy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Major complication ‐ Vascular injury (major vessels and abdominal wall vessels) Open‐entry vs closed‐entry | OR 0.14 [0, 6.82] | 3 studies · 795 participants | Very low Downgraded: risk of bias, imprecision |
Major complication ‐ Visceral injury (bladder or bowel) Open‐entry vs closed‐entry | OR 0.61 [0.06, 6.08] | 3 studies · 795 participants | Very low Downgraded: risk of bias, imprecision |
Major complication ‐ Failed entry Open‐entry vs closed‐entry | OR 0.16 [0.04, 0.63] | 2 studies · 665 participants | Very low Downgraded: risk of bias |
Direct trocar entry compared to Veress needle entry for patients undergoing laparoscopy
Population: patients undergoing laparoscopic surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Major complication ‐ Vascular injury (major vessels and abdominal wall vessels) Direct trocar entry vs Veress needle entry | OR 0.13 [0.03, 0.66] | 5 studies · 1522 participants | Low Downgraded: risk of bias |
Major complication ‐ Visceral injury (bladder or bowel) Direct trocar entry vs Veress needle entry | OR 1.02 [0.06, 16.24] | 4 studies · 1438 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Major complication ‐ Solid organ injury Direct trocar entry vs Veress needle entry | OR 0.16 [0.01, 2.53] | 2 studies · 998 participants | Very low Downgraded: risk of bias, imprecision |
Major complication ‐ Failed entry Direct trocar entry vs Veress needle entry | OR 0.21 [0.14, 0.3] | 7 studies · 3104 participants | Moderate Downgraded: risk of bias |
Direct vision entry compared to Veress needle entry for patients undergoing laparoscopy
Population: patients undergoing laparoscopy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Major complication ‐ Visceral injury (bowel) Direct vision entry vs Veress needle entry | OR 0.15 [0.01, 2.34] | 1 study · 194 participants | Very low Downgraded: risk of bias, imprecision |
Direct vision entry compared to open‐entry for patients undergoing laparoscopy
Population: patients undergoing laparoscopy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Major complication ‐ Visceral injury (bladder or bowel) Direct vision entry vs open‐entry | OR 0.13 [0, 6.5] | 2 studies · 392 participants | Low Downgraded: risk of bias, imprecision |
Major complication ‐ Solid organ injury Direct vision entry vs open‐entry | OR 6.16 [0.12, 316.67] | 1 study · 60 participants | Very low Downgraded: risk of bias, imprecision |
Major complication ‐ Failed entry Direct vision entry vs open‐entry | OR 0.4 [0.04, 4.09] | 1 study · 60 participants | Low Downgraded: risk of bias, imprecision |
Radially expanding (STEP) trocars for primary port entry compared to standard (non‐expanding) trocars for patients undergoing laparoscopy
Population: patients undergoing laparoscopy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Major complication ‐ Vascular injury (major vessels and abdominal wall vessels) Radially expanding (STEP) trocars for primary port entry vs standard (non‐expanding) trocars | OR 0.24 [0.05, 1.21] | 2 studies · 331 participants | Low Downgraded: risk of bias |
Major complication ‐ Visceral injury (bladder or bowel) Radially expanding (STEP) trocars for primary port entry vs standard (non‐expanding) trocars | OR 0.13 [0, 6.37] | 2 studies · 331 participants | Low Downgraded: risk of bias, imprecision |
Major complication ‐ Solid organ injury Radially expanding (STEP) trocars for primary port entry vs standard (non‐expanding) trocars | OR 1.05 [0.07, 16.91] | 1 study · 244 participants | Very low Downgraded: risk of bias, imprecision |
Open entry technique versus closed entry technique for women undergoing laparoscopy
Population: patients with undergoing laparoscopy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Major Complications ‐ Vascular injury Open entry technique vs closed entry technique | OR 0.14 [0, 6.82] | 1 study · 150 participants | Very low Downgraded: risk of bias |
Major Complications ‐ Visceral injury Open entry technique vs closed entry technique | OR 1 [0.06, 16.14] | 1 study · 150 participants | Very low Downgraded: risk of bias |
Minor Complications ‐ Extraperitoneal insufflation Open entry technique vs closed entry technique | OR 0.36 [0.05, 2.61] | 2 studies · 220 participants | Low Downgraded: risk of bias |
Minor Complications ‐ Trocar site bleeding Open entry technique vs closed entry technique | OR 0.14 [0, 6.82] | 1 study · 150 participants | Very low Downgraded: risk of bias |
Minor Complications ‐ Trocar site infection Open entry technique vs closed entry technique | OR 1.21 [0.36, 4.04] | 2 studies · 220 participants | Very low Downgraded: risk of bias |
Major Complications ‐ Failure of entry Open entry technique vs closed entry technique | OR 0.12 [0.02, 0.92] | 1 study · 70 participants | Low Downgraded: risk of bias |
Minor Complications ‐ Injury to mesentery Open entry technique vs closed entry technique | OR 0.14 [0, 6.82] | 1 study · 70 participants | Very low Downgraded: risk of bias |
Direct trocar entry compared to Veress Needle entry for women undergoing laparoscopy
Population: patients with women undergoing laparoscopy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Major Complications ‐ Solid organ injury Direct trocar entry vs Veress Needle entry | OR 0.16 [0.01, 2.53] | 1 study · 598 participants | Very low Downgraded: risk of bias |
Minor Complications ‐ Extraperitoneal insufflation Direct trocar entry vs Veress Needle entry | OR 0.18 [0.13, 0.26] | 5 studies · 2640 participants | Moderate Downgraded: risk of bias |
Minor Complications ‐ Omentum injury Direct trocar entry vs Veress Needle entry | OR 0.28 [0.14, 0.55] | 2 studies · 1212 participants | Low Downgraded: risk of bias |
Minor Complications ‐ Trocar site infection Direct trocar entry vs Veress Needle entry | OR 0.15 [0, 7.36] | 1 study · 212 participants | Very low Downgraded: risk of bias |
Major Complications ‐ Failed entry Direct trocar entry vs Veress Needle entry | OR 0.21 [0.14, 0.31] | 5 studies · 2640 participants | Moderate Downgraded: risk of bias |
Direct vision entry compared to Veress Needle entry for women undergoing laparoscopy
Population: patients with women undergoing laparoscopy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Major outcome ‐ Visceral injury (bowel) Direct vision entry vs Veress Needle entry | OR 0.21 [0.01, 4.49] | 1 study · 194 participants | Very low Downgraded: risk of bias |
Minor Complications ‐ Trocar site bleeding Direct vision entry vs Veress Needle entry | OR 0.53 [0.1, 2.98] | 1 study · 194 participants | Very low Downgraded: risk of bias |
Direct vision entry compared to Open entry technique for women undergoing laparoscopy
Population: patients with women undergoing laparoscopy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Major complications ‐ Solid organ injury Direct vision entry vs Open entry technique | OR 2.54 [0.1, 64.86] | 1 study · 60 participants | Very low Downgraded: risk of bias |
Minor complications ‐ Trocar site bleeding Direct vision entry vs Open entry technique | OR 2.54 [0.1, 64.86] | 1 study · 60 participants | Very low Downgraded: risk of bias |
Major complications ‐ Failed entry Direct vision entry vs Open entry technique | OR 0.39 [0.03, 4.56] | 1 study · 60 participants | Very low Downgraded: risk of bias |
Radially expanding (STEP) trocars for primary port entry compared to Standard trocars for women undergoing laparoscopy
Population: patients with women undergoing laparoscopy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Major Complications ‐ Solid organ injury Radially expanding (STEP) trocars for primary port entry vs Standard trocars | OR 1.05 [0.07, 16.91] | 1 study · 244 participants | Very low Downgraded: risk of bias |
Major Complications ‐ Vascular injury Radially expanding (STEP) trocars for primary port entry vs Standard trocars | OR 0.24 [0.05, 1.21] | 2 studies · 331 participants | Moderate Downgraded: risk of bias |
Major Complications ‐ Visceral injury Radially expanding (STEP) trocars for primary port entry vs Standard trocars | OR 0.13 [0, 6.37] | 2 studies · 331 participants | Low Downgraded: risk of bias |
Minor Complications ‐ Trocar site bleeding Radially expanding (STEP) trocars for primary port entry vs Standard trocars | OR 0.31 [0.15, 0.62] | 3 studies · 421 participants | Low Downgraded: risk of bias |
Cutting trocar compared to Blunt trocars for women undergoing laparoscopy
Population: Women undergoing laparoscopy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Major outcome ‐ Visceral injury Cutting trocar vs Blunt trocars | OR 3.15 [0.13, 78.43] | 1 study · 165 participants | Very low Downgraded: risk of bias |
Minor complications ‐ Trocar site bleeding Cutting trocar vs Blunt trocars | OR 0.32 [0.08, 1.39] | 2 studies · 195 participants | Moderate Downgraded: risk of bias |
Minor complications ‐ Wound infection Cutting trocar vs Blunt trocars | OR 3.15 [0.13, 78.43] | 1 study · 165 participants | Very low Downgraded: risk of bias |
Minor complications ‐ Gas leak events Cutting trocar vs Blunt trocars | OR 1.31 [0.51, 3.35] | 1 study · 165 participants | Low Downgraded: risk of bias |
Transfundal insertion of the Veress Needle compared to Infra‐umbilical insertion of the Veress Needle for women undergoing laparoscopy
Population: patients with women undergoing laparoscopy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Minor Complications ‐ Uterine bleeding Transfundal insertion of the Veress Needle vs Infra‐umbilical insertion of the Veress Needle | OR 7.7 [0.78, 75.76] | 1 study · 100 participants | Very low Downgraded: risk of bias |
Major Complications ‐ Failed entry Transfundal insertion of the Veress Needle vs Infra‐umbilical insertion of the Veress Needle | OR 0.14 [0, 6.82] | 1 study · 100 participants | Very low Downgraded: risk of bias |
Lifting the abdominal wall before Veress Needle insertion compared to Not lifting the abdominal wall before Veress Needle insertion for women undergoing laparoscopy
Population: Women undergoing laparoscopy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Major Complications ‐ Visceral injury Lifting the abdominal wall before Veress Needle insertion vs Not lifting the abdominal wall before Veress Needle insertion | no estimate extracted | 1 study · 150 participants | Ungraded |
Minor Complications ‐ Extraperitoneal insufflation Lifting the abdominal wall before Veress Needle insertion vs Not lifting the abdominal wall before Veress Needle insertion | OR 4.43 [0.98, 20.1] | 1 study · 150 participants | Low Downgraded: risk of bias |
Major Complications ‐ Failed entry Lifting the abdominal wall before Veress Needle insertion vs Not lifting the abdominal wall before Veress Needle insertion | OR 4.44 [2.16, 9.13] | 1 study · 150 participants | Low Downgraded: risk of bias |
Carbon dioxide gas insufflation compared to The use of a gasless abdominal wall retractor for women undergoing laparoscopy
Population: patients with women undergoing laparoscopy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Major Complications ‐ Vascular injury Carbon dioxide gas insufflation vs The use of a gasless abdominal wall retractor | OR 7.23 [0.45, 115.64] | 2 studies · 186 participants | Low Downgraded: risk of bias |
Minor Complications ‐ Extraperitoneal insufflation Carbon dioxide gas insufflation vs The use of a gasless abdominal wall retractor | OR 7.58 [0.77, 74.97] | 1 study · 83 participants | Very low Downgraded: risk of bias |
Minor Complications ‐ Trocar site haematoma Carbon dioxide gas insufflation vs The use of a gasless abdominal wall retractor | OR 0.13 [0, 6.69] | 1 study · 103 participants | Very low Downgraded: risk of bias |
Minor Complications ‐ Wound infection Carbon dioxide gas insufflation vs The use of a gasless abdominal wall retractor | OR 0.98 [0.06, 15.87] | 1 study · 83 participants | Low Downgraded: risk of bias |
A closed technique compared to A parallel technique of Veress Needle insertion for women undergoing laparoscopy
Population: Women undergoing laparoscopy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Major Complications ‐ Vascular injury A closed technique vs A parallel technique of Veress Needle insertion | no estimate extracted | 1 study · 100 participants | Low Downgraded: risk of bias |
Major Complications ‐ Visceral injury A closed technique vs A parallel technique of Veress Needle insertion | no estimate extracted | 1 study · 100 participants | Low Downgraded: risk of bias |
Minor Complications ‐ Extraperitoneal insufflation A closed technique vs A parallel technique of Veress Needle insertion | no estimate extracted | 1 study · 100 participants | Low Downgraded: risk of bias |
5 mm secondary port trocars compared to 3 mm secondary port trocars for women undergoing laparoscopy
Population: Women undergoing laparoscopy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Minor Complications ‐ Trocar site bleeding 5 mm secondary port trocars vs 3 mm secondary port trocars | OR 0.14 [0.01, 2.24] | 1 study · 102 participants | Very low Downgraded: risk of bias |
Radially expanding (STEP) secondary trocars compared to Standard secondary trocars for women undergoing laparoscopy
Population: Women undergoing laparoscopy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Minor Complications ‐ Trocar site bleeding Radially expanding (STEP) secondary trocars vs Standard secondary trocars | OR 0.12 [0.02, 0.92] | 1 study · 68 participants | Moderate |
Minor Complications ‐ Trocar site infection Radially expanding (STEP) secondary trocars vs Standard secondary trocars | OR 0.14 [0.01, 2.21] | 1 study · 61 participants | Very low Downgraded: risk of bias |