European journal of obstetrics, gynecology, and reproductive biology · 2025
Does the abdominal entry method in laparoscopy really matter? A network meta-analysis of rare events in randomized trials.
СтатьяМетаанализОбзорНазвание и аннотация: Перевод в очереди
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Gardella Barbara, Dominoni Mattia, Cassani Chiara, Pano Martina Rita, Camnasio Cristina Angela, Spinillo Arsenio
Аннотация
OBJECTIVE: To evaluate the risk of major injuries associated with Veress, open (Hasson), direct and optical abdominal entry methods in laparoscopy.
METHODS: Network meta-analysis was performed using penalized logistic regression. Pairwise meta-analysis was carried-out using Bayesian binomial-normal hierarchical models with weakly informative priors. Risk of bias was evaluated by ROB-2 method. NMA protocol was recorded in PROSPERO (n. CRD42024583526).
RESULTS: Vascular lesions occurred in 14/2832 of Veress, 1/1661 of direct, 2/426 of optical and 0/2030 of open entry methods in 26 studies of 7250 laparoscopies. In NMA, direct and open entry methods were associated with a reduced risk of vascular lesions compared to Veress (OR = 0.17,95 %CI = 0.04-0.67 and OR = 0.09,95 %CI = 0.01-0.68,respectively). Overall, pooled rates of major injuries were 0.76/1000 (95 % CI = 0.06-2.05) in 29 studies of 7584 subjects. Major injuries were less common in direct as compared to either Veress (OR = 0.21,95 %CI = 0.08-0.56) or open method (OR = 0.23,95 %CI = 0.07-0.73). According to a ranking evaluation of absence of major complications, direct entry (SUCRA = 84.3 %) had the highest cumulative proportion of success, followed by optical entry (SUCRA = 68.5 %). Minor complications including extraperitoneal insufflation, multiple attempts, omental injury, trocar bleeding or infection or incisional hernia were studied in a network of 8984 subjects in 33 studies with a pooled prevalence of 30/1000 (95 %CI = 26.7-34.7). The risk of minor injuries was lower in direct (OR = 0.33,95 %CI = 0.23-0.46) as opposed to Veress entry. Direct entry was also the method with the lowest cumulative proportion of minor injuries (SUCRA = 97.75).
CONCLUSION: The open entrance method prevents vascular but not visceral injury. Overall, direct entry into the abdomen causes fewer severe and minor complications than Veress. In a hierarchy of procedures with fewer complications, direct entrance ranks first among the four most common methods of abdominal entry to establish pneumoperitoneum.
METHODS: Network meta-analysis was performed using penalized logistic regression. Pairwise meta-analysis was carried-out using Bayesian binomial-normal hierarchical models with weakly informative priors. Risk of bias was evaluated by ROB-2 method. NMA protocol was recorded in PROSPERO (n. CRD42024583526).
RESULTS: Vascular lesions occurred in 14/2832 of Veress, 1/1661 of direct, 2/426 of optical and 0/2030 of open entry methods in 26 studies of 7250 laparoscopies. In NMA, direct and open entry methods were associated with a reduced risk of vascular lesions compared to Veress (OR = 0.17,95 %CI = 0.04-0.67 and OR = 0.09,95 %CI = 0.01-0.68,respectively). Overall, pooled rates of major injuries were 0.76/1000 (95 % CI = 0.06-2.05) in 29 studies of 7584 subjects. Major injuries were less common in direct as compared to either Veress (OR = 0.21,95 %CI = 0.08-0.56) or open method (OR = 0.23,95 %CI = 0.07-0.73). According to a ranking evaluation of absence of major complications, direct entry (SUCRA = 84.3 %) had the highest cumulative proportion of success, followed by optical entry (SUCRA = 68.5 %). Minor complications including extraperitoneal insufflation, multiple attempts, omental injury, trocar bleeding or infection or incisional hernia were studied in a network of 8984 subjects in 33 studies with a pooled prevalence of 30/1000 (95 %CI = 26.7-34.7). The risk of minor injuries was lower in direct (OR = 0.33,95 %CI = 0.23-0.46) as opposed to Veress entry. Direct entry was also the method with the lowest cumulative proportion of minor injuries (SUCRA = 97.75).
CONCLUSION: The open entrance method prevents vascular but not visceral injury. Overall, direct entry into the abdomen causes fewer severe and minor complications than Veress. In a hierarchy of procedures with fewer complications, direct entrance ranks first among the four most common methods of abdominal entry to establish pneumoperitoneum.