Access devices usually comprised another cannula along with a removable sharp pyramidal trocar for penetration of the abdominal wall, and were nearly universally positioned following establishment of the pneumoperitoneum.
However, it is apparent that such devices and techniques bring about patient morbidity through visceral and vascular injury, as well as incision-related complications such as dehiscence and hernia. There exist alternative approaches to positioning insufflation needles and the initial cannula, which may reduce the incidence of vascular and visceral injury specifically in the face of previous abdominal surgery.
Inserting the first cannula after minilaparotomy is associated with a lower risk of vascular injury, but visceral complications still occur. Newer and more effective access instruments may lessen the risk of some complications related to 'blind entry', and while not all seem to be effective in connection with this, some blunt-tipped devices now exist, which are surprisingly easy to position and could limit the risk of injury while significantly lowering the size of the myofascial defect in the abdominal wall.
Port site metastasis is a relatively newly recognized complication of oncological surgery and it is a concern, but further investigation is needed to determine whether such metastasis is related to a general change in clinical outcome.
The incidence and spectrum of access-related complications is greater than previously perceived. Newer devices and adjustments to technique may lessen the incidence of such adverse events.
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