'Fail-Safe' First Abdominal Entry for Laparoscopic/Robotic Surgery ("Streaming Hollow-Entry")

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added:
3 weeks ago
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1634
specialty:
General Surgery

Case description

Briefly: It is an undeniable fact that the global surgical community is faced with an unacceptable statistic of laparoscopic/robotic abdominal entry 'accidents' (entry complications should be defined as accidents: unanticipated/ unexpected, 'done deal', once they occur). I propose a 'fail-safe' technique for first abdominal entry that focuses primarily on prevention. Despite the fact that all abdominal entry methods are 99.9% safe and successful, surgery is performed by humans, thus accidents will occur. "Streaming hollow-entry" was designed with meticulous attention to prioritize preventative measures at each phase of the procedure. Clearly, prevention is the most effective strategy to avoid accidents. Premise: since the current plethora of entry systems are implicated in these accidents, delaying their introduction until 'fail-safe' conditions are established is a logical preventative to mitigate the potential risks associated with this critical and mandatory first step for all laparoscopic/robotic surgeries. Prevention is the key to accident avoidance. My opinion is that the conventional surgical teaching to begin entry with a sharp/pointed instrument is a miscalculation, a fundamental concept that should be critiqued and re-considered. The variables and pitfalls associated with initial abdominal access have always existed and remain a constant that  each generation of surgeons must overcome. If the entry systems and sequence of steps remain the same, the unacceptable statistics of entry accidents will remain unchanged for the next generation. 

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