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ssss1 Reusable Thoracoport.

Source: Photo courtesy of Dr. Philipp Mayhew.

Most insertional complications can be avoided with special attention to detail and do not usually require the need for conversion to an open procedure. Complications associated with trocar placement and insufflation include damage to intraabdominal organs, vascular injury, subcutaneous insufflation (emphysema), fatal air embolism, and insufflation of falciform fat [15]. Insertion of the Veress needle via the intercostal technique in one article was associated with 35% grade 1 complications (subcutaneous emphysema, omental or falciform injuries), 10.7% grade 2 complications (liver of splenic injuries), and 1.7% grade 3 complications (pneumothorax) [16]. Insertion of the Veress needle and primary trocar for initial entry remains the most hazardous part of laparoscopy, accounting for 40% of all laparoscopic complications and the majority of the fatalities [17]. Despite decades of research and development to find safer methods for initial laparoscopic entry, major vessel injuries have been reported using virtually all types of trocar insertion methods. The overall morbidity and mortality rates related to laparoscopic access are low. The life‐threatening complications include injury to the bowel, bladder, and major abdominal vessels. A recent Cochrane review included 17 randomized controlled trials concerning 3040 individuals undergoing laparoscopy. Overall, there was no evidence of advantage using any single abdominal access technique in terms of preventing major complications [18].