Understanding Laparoscopic Access
Laparoscopic surgery relies on establishing a safe entry point into the abdominal cavity, which is then inflated with gas (pneumoperitoneum) to create working space. Entry can be achieved through two main methods: the closed Veress technique (blind insertion) or the open Hasson technique (direct visualization).
The History Behind the Hasson Technique
Dr. Harrith Hasson developed this technique in 1971 to reduce risks associated with the blind entry method. By providing visual confirmation during abdominal access, the Hasson method significantly improves patient safety, especially in high-risk individuals with potential adhesions or anatomical variations.
A Step-by-Step Procedure Guide
- Incision: A small cut is made, usually near the navel.
- Dissection: The surgeon carefully dissects through the abdominal wall layers under direct vision.
- Fascia Isolation: The fascial layer is identified, and two anchoring sutures are placed on either side.
- Peritoneum Entry: The peritoneum is opened with direct visualization.
- Trocar Insertion: A blunt-tipped Hasson trocar is inserted through the incision.
- Suture Fixation: The anchoring sutures are tied to the trocar cannula for security and a gas-tight seal.
- Insufflation and Confirmation: Gas is introduced, and the laparoscope is inserted for visual check before the main surgery.
The Crucial Role of Sutures
The sutures are integral to the Hasson technique for sutures, providing firm fixation of the trocar. This prevents slippage, maintains the gas seal necessary for visualization, and can help minimize the risk of post-operative port-site hernias by securing the fascial closure at the end of the procedure.
Hasson vs. Veress: A Comparative Analysis
| Feature | Hasson Technique (Open) | Veress Technique (Closed) |
|---|---|---|
| Entry Method | Direct visualization | Blind insertion |
| Equipment | Blunt trocar, sutures | Sharp Veress needle, standard trocar |
| Primary Goal | Maximize safety and control | Maximize speed and efficiency |
| Indications | Prior abdominal surgery, obesity, adhesions | Low-risk patients, uncomplicated cases |
| Time | Slightly longer setup | Faster initial entry |
| Leakage | Less risk of gas leak (suture-secured) | Higher potential for gas leak |
| Risk of Injury | Lower risk of major vascular/bowel injury | Small but present risk of blind injury |
Ideal Candidates for the Hasson Technique
The Hasson technique is the preferred choice for patients with increased risk factors, including:
- History of previous abdominal surgeries, which may lead to adhesions.
- Obesity, where abdominal wall thickness can complicate blind entry.
- Pediatric patients.
- Cases where initial blind entry attempts with the Veress needle are unsuccessful.
The Evolution and Modern Application
The Hasson technique remains a vital component of modern surgical training and practice. Its core principle of open access with suture fixation for safety is still widely applied, sometimes with minor modifications. Surgeons are typically proficient in both the Hasson and Veress methods, allowing them to choose the safest option based on individual patient needs and history. This reflects the medical field's ongoing dedication to improving surgical safety and outcomes. For further reading on surgical standards, authoritative guidelines are available from bodies such as the American College of Surgeons.
Conclusion
The Hasson technique for sutures is a specialized, open procedure for safe initial access in laparoscopic surgery. By employing direct visualization and anchoring sutures, it significantly enhances safety, particularly for patients with complex medical histories or anatomical challenges, making it an indispensable technique in contemporary surgical practice.
