Camera-less Peritoneal Entry for Urologic (c-pet) Laparoscopy: Description of a Novel Technique

Background:
Use of the EndoTIP rotational access port (Karl Storz, GMBH) with visual recognition and without prior insufflation has previously been shown to be a safe and efficient technique for obtaining peritoneal access for laparoscopic surgery1. An alternative peritoneal entry detection technique using a fluid column instead of a camera lens was evaluated.
Methods:
After obtaining ethics approval, we prospectively treated 70 consecutive patients undergoing laparoscopic urological surgery using EndoTIP access without prior insufflation. Patients had no history of abdominal surgery. A fluid column situated within the lumen of the access port was used to detect cavity entry instead of direct visualization of peritoneal penetration through a camera lens. Primary outcome measures were the success of peritoneal access, the rate of intra-abdominal injuries and entry time.
Results:
Following an introductory roll-in phase, 70 cases were completed with this technique. The Fluid-Column Peritoneal Entry Detection method successfully recognized peritoneal entry in 100% of the cases. No intra-abdominal injuries were observed. Mean access time was 23 seconds.
Conclusions:
A dropping fluid column within the lumen of the EndoTIP access port is a practical technique to detect peritoneal entry during laparoscopic procedures. This novel peritoneal entry method is safe and effective. We hypothesize that this method is safer than current techniques as it excludes the need for visual recognition thereby shortening the learning curve.

1 Hickey, L. Rendon, R; JOURNAL OF ENDOUROLOGY Volume 20, Number 9, September 2006


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Program Number: P511

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