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Laparoscopic Abdominal Entry by the Ternamian Threaded Visual System

  • Artin Ternamian
Chapter

Abstract

The word endoscopy is of Greek derivation in which endon means internal, and skopein means to examine. Healers from Hippocrates’ time have adapted primitive viewing instruments to peer into dark and yet-undiscovered body crevasses, in an attempt to understand and relieve human suffering [1]. Despite considerable technologic advancements, endoscopy retains three principal elements to accomplish its objective. The first comprises a flexible or rigid viewing tube endoscope to transmit light into the body cavity and convey back images for the surgeon to observe. The second consists of an array of ancillary surgical instruments to enable the operator to perform minimally invasive diagnostic and therapeutic tasks. The third is an anchored access system that leads instruments in and out of body compartments without loss of distention or orientation. These conduits (ports) are either surgically created temporary invariant entry points (thoracoscopy, laparoscopy, culdoscopy), through natural orifices, without requiring entry wounds (bronchoscopy, colonoscopy, hysteroscopy) or through contemporary hybrid conduits (Natural Orifice Transluminal Endoscopic Surgery [NOTES]).

Keywords

Peritoneal Membrane Penetration Force Entry Method Inadvertent Injury Osseous Scaffolding 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Robinson V. Preface. In: Leonardo R, editor. History of gynecology. New York: Forben Press; 1944.Google Scholar
  2. 2.
    Nieboer TE, Johnson N, Lethaby A, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009;25(1):CD003677.Google Scholar
  3. 3.
    Chapron C, Fauconnier A, Coffinet F, et al. Laparoscopic surgery is not inherently dangerous for patients presenting with benign gynecologic pathology: results of a meta-analysis. Hum Reprod. 2002;17:1334–42.PubMedCrossRefGoogle Scholar
  4. 4.
    Fuller J, Ashar BS, Carey-Corrado J. Trocar-associated injuries and fatalities: an analysis of 1399 reports to the FDA. J Minim Invasive Gynecol. 2005;12:302–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Garry R. A consensus document concerning laparoscopic entry techniques: Middlesbrough. Gynecol Endosc. 1999;8:403–6.CrossRefGoogle Scholar
  6. 6.
    Vilos GA, Ternamian A, Dempster J, et al. Laparoscopic entry: a review of techniques, technologies, and complications. J Obstet Gynaecol Can. 2007;29:433–65.PubMedGoogle Scholar
  7. 7.
    Garry R. Toward evidence based laparoscopic entry techniques: clinical problems and dilemmas. Gynecol Endosc. 1999;8:315–26.CrossRefGoogle Scholar
  8. 8.
    Vilos GA, Hancock G, Penava DA, Kozak I, Davies W. Nine cases of bowel injury during 3472 laparoscopies. J Obstet Gynecol Can. 1999;21:144–50.Google Scholar
  9. 9.
    Laparoscopic trocar injuries: a report from a U.S. Food and Drug Administration (FDA). Center for Devices and Radiological Health (CDRH) Systematic Technology Assessment of Medical Products (STAMP) Committee. (Cited 2003 Nov 7). Available from: URL: http://www.fda.gov/cdrh/medicaldevicesafety/stamp/trocar.html.
  10. 10.
    Institute of Medicine. To err is human. Building a safer health system. Washington, DC: National Academy Press; 1999.Google Scholar
  11. 11.
    Philip PA, Amaral JF. Abdominal access complications in laparoscopic surgery. J Am Coll Surg. 2001;192(4):525–36.CrossRefGoogle Scholar
  12. 12.
    Passerotti CC, Begg N, Penna FJ, et al. Safety profile of trocar and insufflation needle access systems in laparoscopic surgery. J Am Coll Surg. 2009;209(2):222–32.PubMedCrossRefGoogle Scholar
  13. 13.
    Bogner MS. Medical devices and human error. In: Mouloua M, Parasuraman R, editors. Human performance in automated systems: current research and trends. Hillsdale: Lawrence Erlbaum; 1994. p. 64–7.Google Scholar
  14. 14.
    Ahmad G, Duffy J, Phillips K, et al. Laparoscopic entry techniques. Cochrane Database Syst Rev. 2008;2:CD006583.PubMedGoogle Scholar
  15. 15.
    Garry R. Surgeons may continue to use their chosen entry technique. Gynecol Surg. 2009;6:87–92; discussion 91–2.CrossRefGoogle Scholar
  16. 16.
    Vilos GA, Vilos AG, Abu-Rafea B, et al. Three simple steps during closed laparoscopic entry may minimize major injuries. Surg Endosc. 2009;23:758–64.PubMedCrossRefGoogle Scholar
  17. 17.
    Ternamian A. Laparoscopic access. In: Jain N, editor. State of the art atlas of endoscopic surgery in infertility and gynecology: Laparoscopic access, vol. 2. New Delhi: Jaypee Bros; 2010. p. 20–33.Google Scholar
  18. 18.
    String A, Berber E, Foroutani A, et al. Use of the optical access trocar for safe and rapid entry in various laparoscopic procedures. Surg Endosc. 2001;15:570–3.PubMedCrossRefGoogle Scholar
  19. 19.
    Patkin M, Isabel L. Ergonomics, engineering and surgery of endosurgical dissection. J R Coll Surg Edinb. 1995;40:120–32.PubMedGoogle Scholar
  20. 20.
    Cuschieri A. Whither minimal access surgery: tribulations and expectations. Am J Surg. 1995;1:9–19.CrossRefGoogle Scholar
  21. 21.
    Hanna GB, Shimi SM, Cuschieri A. Optimal port locations for endoscopic intracorporeal knotting. Surg Endosc. 1997;11:397–401.PubMedCrossRefGoogle Scholar
  22. 22.
    Quick NE, Gilette JC, Shapiro R, et al. The effect of using laparoscopic instruments on muscle activation patterns during minimally invasive training procedures. Surg Endosc. 2003;17:462–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Emam TA, Hanna GB, Kimber C, et al. Effect of intracorporeal-extracorporeal instrument length ratio on endoscopic task performance and surgeon movements. Arch Surg. 2000;135:62–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Beurger R, Forkey D, Smith WD. Ergonomic problems associated with laparoscopic surgery. Surg Endosc. 1999;13:466–8.CrossRefGoogle Scholar
  25. 25.
    Beurger R, Smith WD, Chung YH. Performing laparoscopic surgery is significantly more stressful for the surgeon than open surgery. Surg Endosc. 2001;15:1204–7.CrossRefGoogle Scholar
  26. 26.
    Moorthy K, Munz Y, Dosis A, et al. The effect of stress-induced conditions on the performance of a laparoscopic task. Surg Endosc. 2003;17:1481–4.PubMedCrossRefGoogle Scholar
  27. 27.
    Taffinder N, McManus IC, Gul Y, et al. Objective assessment of the effect of sleep deprivation on surgical psychomotor skill. Lancet. 1999;353:1191.Google Scholar
  28. 28.
    Sexton JB, Thomas EJ, Helmreich RL. Error, stress, and teamwork in medicine and aviation: cross-sectional survey. BMJ. 2000;320:745–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Ternamian A. Endoskopische abdominalchirurgie in der Gynäkologie. In: Mettler L, editor. Stuttgart: Schattauer; 2002. p. 175–80.Google Scholar
  30. 30.
    Corson SL, Batzer FR, Gocial B, et al. Measurement of the force necessary for laparoscopic trocar entry. J Reprod Med. 1989;34(4):282–4.PubMedGoogle Scholar
  31. 31.
    Singh S, Marcoux V, Ternamian A, et al. Core competencies for gynecologic endoscopy in residency training: a national consensus project. J Minim Invasive Gynecol. 2009;16(1):1–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Raymond E, Ternamian A, Tolomiczenko G. Endoscopy teaching in Canada: a survey of obstetrics and gynecology program directors and graduating residents. J Minim Invasive Gynecol. 2006;13:10–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Munro MG. Laparoscopic access: complications, technologies and techniques. Curr Opin Obstet Gynecol. 2002;14(4):365–74.PubMedCrossRefGoogle Scholar
  34. 34.
    Ternamian A. Port creation during laparoscopic hysterectomy. In: Mettler L, editor. Manual for laparoscopic and hysteroscopic gynecological surgery. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2007. p. 175–80.Google Scholar
  35. 35.
    Ternamian AM. Laparoscopy without trocars. Surg Endosc. 1997;11:815–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Glass KB, Tarnay CM, Munro MG. Intra-abdominal pressure and incision parameters associated with a pyramidal laparoscopic trocar-cannula system and the EndoTIP cannula. J Am Assoc Gynecol Laparosc. 2002;9(4):508–13.PubMedCrossRefGoogle Scholar
  37. 37.
    Ternamian AM. A trocarless, reusable, visual-access cannula for safer laparoscopy: an update. J Am Assoc Gynecol Laparosc. 1998;5(2):197–201.PubMedCrossRefGoogle Scholar
  38. 38.
    Mettler L, Schmidt E, Frank V, Semm K. Optical trocar systems: laparoscopic entry and its complications (a study of cases in Germany). Gynaecol Endosc. 1999;8:383–9.CrossRefGoogle Scholar
  39. 39.
    Vilos GA. The ABCs of a safer laparoscopic entry. J Minim Invasive Gynecol. 2006;13:249–51.PubMedCrossRefGoogle Scholar
  40. 40.
    Kroft J, Aneja A, Ternamian A, et al. Laparoscopic peritoneal entry preferences among Canadian gynaecologists. J Obstet Gynecol Can. 2009;31:641–8.Google Scholar
  41. 41.
    Teoh B, Sen R, Abbott J. An evaluation of four tests used to ascertain Veress needle placement at closed laparoscopy. J Minim Invasive Gynecol. 2005;12:153–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Abu-Rafea B, Vilos GA, Vilos AG. High-pressure laparoscopic entry does not adversely affect cardiopulmonary function in health women. J Minim Invasive Gynecol. 2005;12:475–9.PubMedCrossRefGoogle Scholar
  43. 43.
    Phillips G, Garry R, Kumar C, et al. How much gas is required for initial insufflation at laparoscopy? Gynaecol Endosc. 1999;8:369–74.CrossRefGoogle Scholar
  44. 44.
    Reich H, Robeiro SC, Rasmussen C, et al. High-pressure trocar insertion technique. J Soc Laparoendosc Surg. 1999;3:45–8.Google Scholar
  45. 45.
    McDougall E, Figenshau RS, Clayman RV. J Laparosc Surg. 1994;4:6.Google Scholar
  46. 46.
    Ternamian A. How to improve laparoscopic access safety: ENDOTIP. Min Invas Ther Allied Technol. 2001;10(1):31–9.CrossRefGoogle Scholar
  47. 47.
    Audebert AJ. The role of micro-laparoscopy in the diagnosis of peritoneal and visceral adhesions and in the prevention of bowel injury associated with blind trocar insertion. Fertil Steril. 2000;73:631–5.PubMedCrossRefGoogle Scholar
  48. 48.
    Lower AM, Hawthorn RJS, Ellis H, et al. The impact of adhesions on hospital readmissions over ten years after 8849 open gynaecological procedures: an assessment from the Surgical and Clinical Adhesions Research Study. Br J Obstet Gynecol. 2000;107:855–62.CrossRefGoogle Scholar
  49. 49.
    Childers JM, Brzechffa PR, Surwit EA. Laparoscopy using the left upper quadrant as the primary trocar site. Gynaecol Oncol. 1993;50:221–5.CrossRefGoogle Scholar
  50. 50.
    Ternamian AM, Vilos GA, MacLeod NT, et al. Laparoscopic peritoneal entry with the reusable threaded visual cannula. J Minim Invasive Gynecol. 2010;17:461–7.PubMedCrossRefGoogle Scholar
  51. 51.
    Ternamian A, Deitel M. Endoscopic threaded imaging port (EndoTIP) for laparoscopy: experience with different body weights. Obes Surg. 1999;2:44–7.CrossRefGoogle Scholar
  52. 52.
    Sutton C. A practical approach to diagnostic laparoscopy. In: Sutton C, Diamond M, editors. Endoscopic surgery for gynaecologists. London: WB Saunders; 1993. p. 21–7.Google Scholar
  53. 53.
    Yuzpe A. Pneumoperitoneum needle and trocar injuries in laparoscopy. A survey on possible contributing factors and prevention. J Reprod Med. 1990;35:485–90.PubMedGoogle Scholar
  54. 54.
    Luijendijk RW, Hop WCJ, van den Tol MP. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 2000;343:392–8.PubMedCrossRefGoogle Scholar
  55. 55.
    Montz FJ, Holschneider CH, Munro MG. Incisional hernias following laparoscopy: a survey of the American Association of Gynecologic Laparoscopists. Obstet Gynecol. 1994;84:881–4.PubMedGoogle Scholar
  56. 56.
    Mayol J, Garcia-Aguilar J, Ortiz-Oshiro E, De-Diego Carmona J, Fernandez Represa JA. Risks of the minimal access approach for laparoscopic surgery: multivariate analysis of morbidity related to umbilical trocar insertion. World J Surg. 1997;21:529–33.PubMedCrossRefGoogle Scholar
  57. 57.
    Azurin DJ, Go LS, Arryo LR, et al. Trocar site herniation following laparoscopic cholecystectomy and the significance of incidental preexisting umbilical hernia. Am Surg. 1995;5:419–21.Google Scholar
  58. 58.
    Tarnay CM, Glass KB, Munro MG. Entry force and intra-abdominal pressure associated with six laparoscopic trocar-cannula systems: a randomized comparison. Obstet Gynecol. 1999;94:83–8.PubMedCrossRefGoogle Scholar
  59. 59.
    Hurd WW, Wang L, Schemmel MT. A comparison of the relative risk of vessel injury with conical versus pyramidal laparoscopic trocars in a rabbit model. Am J Obstet Gynecol. 1995;173:1731–3.PubMedCrossRefGoogle Scholar
  60. 60.
    Leibl BJ, Schmedt CG, Schwarz J, et al. Laparoscopic surgery complications associated with trocar tip design: review of literature and own results. J Laparoendosc Adv Surg Tech A. 1999;9:135–40.PubMedCrossRefGoogle Scholar
  61. 61.
    Leonard F, Lecuru F, Rizk E, et al. Perioperative morbidity of gynecological laparoscopy: a prospective monocenter observational study. Acta Obstet Gynecol Scand. 2000;79:129–34.PubMedCrossRefGoogle Scholar
  62. 62.
    Paya K, Wurm J, Fakhari M, et al. Trocar-site hernia as a typical postoperative complication of minimally invasive surgery among preschool children. Surg Endosc. 2008;22:2724–7.PubMedCrossRefGoogle Scholar
  63. 63.
    Gill IS, Advincula AP, Aron M, et al. Consensus statement of the consortium for laparoscopic single-site surgery. Surg Endosc. 2010;24:762–8.PubMedCrossRefGoogle Scholar
  64. 64.
    Uppal S, Frumovitz M, Escobar P, et al. Laparoscopic single-site surgery in gynecology: review of literature and available technology. J Minim Invasive Gynecol. 2011;18(1):12–23.PubMedCrossRefGoogle Scholar
  65. 65.
    Romanelli JR, Earle DB. Single-port laparoscopic surgery: an overview. Surg Endosc. 2009;23:1419–27.PubMedCrossRefGoogle Scholar
  66. 66.
    Andou M, Yoshioka K, Ternamian A. A new approach for accessing retroperitoneal space using a 5 mm visual access cannula. Surg Endosc. 2003;17:1158–61.PubMedCrossRefGoogle Scholar
  67. 67.
    Palmer R. Safety in laparoscopy. J Reprod Med. 1974;13:1–5.PubMedGoogle Scholar
  68. 68.
    Chapron C, Pierre F, Harchaoui Y, et al. Gastrointestinal injuries during gynaecological laparoscopy. Hum Reprod. 1999;14:337.Google Scholar

Copyright information

© Springer-Verlag London Limited 2012

Authors and Affiliations

  • Artin Ternamian
    • 1
  1. 1.Department of Obstetrics & Gynecology, Faculty of MedicineUniversity of Toronto, St. Joseph’s Health CentreTorontoCanada

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