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Re: Hasson versus Verres insufflation.From: Thomas Ind (100333.1216@compuserve.com)Wed Dec 23 23:26:38 1998
Good theory but incorrect. The rate of injury from Veress is probably higher that than quoted and most probably go unrecognised. The simple fact is that you are twice as likely to puncture bowel with your trocar if you use the Veress approach and half as likely to recognise it. However, even if someone such as yourself did convert to a Hasson entry you would only stand an evens chance of preventing one bowel trauma every ten years and would have a less than evens chance of preventing one death in your career. I therefore quite understand gynaecologists who still prefer the Veress approach. I have changed as I aspire to the highest possible standards of evidenced based medicine and am young enough to learn new techniques. My changing makes no impact on the global safety of laparoscopy. If, however, others changed, this may make an impact. Furthermore, I can see no argument in favour of a Veress approach. Although I am sympathetic with the argument for a Veress approach in a 'virgin' abdomen, the safety of any surgical methodology must surely be greater if the surgeon has a larger experience with it's use. I've considered all this and decided on a Hasson entry as my routine. I'll still damage bowel on average 4-5 times every 10,000 laparoscopies. However, I see no disadvantages with this technique and therefore see no reason to compromise even it is only a very small one. I've already argued that a Hasson method is no slower if the surgeon uses it routinely. However, I'm sure if you use it for a one off it would take a long time as you, your assistent, and scrub nurse would not be used to it.
-- Dr Thomas Ind MB BS MD MRCOG St George Hospital Kogarah Sydney NSW 2217 AUSTRALIA
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