The use of stab incisions for instrument access in laparoscopic operations

Background/Purpose: Traditional laparoscopic approaches require cannulas for instrument access to the abdominal cavity. This study reports the authors' experience using minimal access (MA) stab incisions, rather than cannulas, for insertion of laparoscopic instruments into the peritoneal cavity. Methods: All patients undergoing MA procedures by the authors from November 1999 through March 2003 were included. Procedures included foregut, biliary, adrenal, splenic, colonic, and genitourinary operations. A single cannula was used for insertion of the telescope. In select cases, a second cannula was needed for unique instruments (staplers/ultrasonic shears). Abdominal wall stab incisions (SI) were used for introduction of the remaining instruments. Results: A total of 511 MA procedures were performed during the study period. Pneumoperitoneum was maintained in all cases. There were no complications associated with creation of the SI. A single-Step reposable (partially reusable, partially disposable) cannula and expandable sheath were used in 308 cases, whereas a second-Step reposable cannula and sheath were needed in 203 children. In total, 1,337 cannulas were saved using this MA technique. The cost to the patient was $140/Step cannula and sheath; overall cost savings were $187,180. Conclusions: MA procedures can be performed safely and effectively with a single or, occasionally, 2 cannulas. The cosmetic result is superior, and there are significant cost savings related to the elimination of accessory cannulas. The authors believe this technique of SI for instrument access is superior to the traditional cannula approach and can be utilized in most laparoscopic operations.