Laparoscopic entry technique-a survey of practices of consultant gynaecologists

To assess the mode of laparoscopic entry technique among consultant gynaecologists in the United Kingdom and Ireland and to find out whether recent recommendations have influenced practice, an anonymous postal questionnaire was sent to 1,190 gynaecologists. Responses were analysed using an Excel spreadsheet. There was a 64% response rate. Of the respondents, the majority (90%) performed laparoscopy by using a Veress needle technique. Regarding the patient's position when inserting the scope, 61% used lithotomy with Trendelenberg tilt, and 39% used the flat position. The entry point used was subumbilical by 54% and intraumbilical by 44%. Thirty-eight percent used pressure and 62% used volume to decide when to insert the primary trocar. Only 26% of responding gynaecologists were aware of the Middlesbrough consensus document, but most who had attended a course were compliant with the guidelines. In conclusion, the majority of gynaecologists practiced closed laparoscopy and used the volume technique to achieve pneumoperitoneum. Only a small number of gynaecologists were aware of the recent recommendations regarding safe laparoscopic entry technique, suggesting that methods for disseminating recommendations must be improved.