Access devices usually comprised an external cannula and a removable sharp pyramidal trocar for penetration from the abdominal wall, and were nearly universally positioned following establishment of the pneumoperitoneum. However, it is apparent that such devices and methods contribute to patient morbidity through visceral and vascular injury, as well as incision-related complications such as dehiscence and hernia.
There exist alternative methods to positioning insufflation needles and the initial cannula, which might lessen the incidence of vascular and visceral injury specifically in the face of previous abdominal surgery. Inserting the first cannula after minilaparotomy is assigned to a reduced risk of vascular injury, but visceral complications still occur. Some new access instruments may reduce the risk of some complications associated with 'blind entry', and although not all seem to be effective in this regard, some blunt-tipped devices now exist, which are surprisingly easy to position and may limit the risk of injury while significantly reducing the size the myofascial defect in the abdominal wall.
Port site metastasis is a relatively newly recognized complication of oncological surgery and is an issue, but further investigation is needed to determine whether such metastasis relates to a change in clinical outcome.
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