Laparoscopic Access Techniques: Experience in a Developing Country, Sudan

Abstract

Background: Minimal access surgery has revolutionized the field of surgery. Access to the abdominal cavity represents a critical step in laparoscopic procedures. Various techniques have been used to obtain safe access into the abdominal cavity, with no apparent superiority of one technique over another. Aim: This study was conducted to assess the different types of laparoscopic access techniques used at Almak Nimir University Hospital in the period from January to December 2019. Methodology: This descriptive cross-sectional study compared the use and outcomes of different laparoscopic access techniques in various laparoscopic procedures performed at Almak Nimir University Hospital, (Shendi University, Shendi, Sudan). Results: The study included 324 patients with a mean age of 26.2±15.3 years (range 1–85 years). Most of the patients were female (266 patients, 82.1%). Of the laparoscopic procedures, 77.2% were laparoscopic appendicectomy while 18.8% were laparoscopic cholecystectomy. The Veress needle technique was used in 158 patients (49.7%), the open technique was used in 97 patients (29.9%) and direct trocar insertion was used in 66 patients (20.4%). Direct trocar insertion showed a statistically shorter procedure duration (mean 2.9±0.9 min) compared to the other techniques (p=0.001). Access-related complications occurred in five patients (0.6%), but there was no statistically significant difference between the three access techniques. Conclusion: This study confirms the safety of various access techniques used in laparoscopic procedures; however, the choice of access type should be individualized.