Re: Hasson versus Verres insufflation.
From: art fougner, md (evsono@pipeline.com)
Fri Dec 18 08:41:54 1998
and what about direct primary trocar insertion in low risk patients?
art
a Happy and a Merry
At Fri, 18 Dec 1998, Thomas Ind wrote:
>
>For the last 12 months I have decided to abandon the Verres approach.
>The evidence is as follows.
>
>The risk of bowel damage from all laparoscopies with a Verres is
>14/10,000 with a 4% mortality. The percentage that are recognised at
>the time of injury is 34%. With a Hasson the risk is 5/10,000;
>mortality is unreported; and 60% are recognised at the time of injury.
>
>The risk of major vascular damage is between 5 and 10 per 10,000
>(depending on what paper you read). There is an 8% mortality. To date
>there have been no case reports of vascular damage following a Hasson
>entry.
>
>Put into prospective, if you do 100 laparoscopies a year, you may
>prevent one bowel injury in 10 years and are unlikely to prevent a death
>in your career by converting to the Hasson approach.
>
>The above are observational studies only. There is one randomised
>controlled study that shows a halving of bowel injuries but that was in
>high risk patients only.
>
>The 2 big arguments against the Hasson approach is that it can not be
>performed if you use a 5mm scope (which I do not have); and that it is
>time consuming. I have timed a colleague connect the Verres, check the
>needle, test the gas, insufflated, white set, insert the trocar and then
>the laparoscope. On average, he is only 19 seconds quicker that I am at
>getting the scope in so I feel that the later argument is worthless.
>
>How many on the forum routinely use the Hasson approach above the blind
>Verres appraoch? Bearing in mind that I have given a balanced argument
>in favour of the Hasson, how many feel that it is worthwhile learning in
>view of the limited advantages presented and the limitations with the
>evidence?
>
>--
>Thomas Ind MB BS MD MRCOG
>St George Hospital
>Kogarah
>Sydney
>Australia
>
>For every complex problem there is a simple solution...and it's wrong. (H L Mencken).
>
--
art fougner, md
SonoScan/Genetic Sciences
forest hills, ny
evsono@pipeline.com
