The principles of safe laparoscopic surgery

The well-established benefits of laparoscopic surgery over open surgery and the rapid technology developments have meant that in just over 30 years laparoscopy has become the first-line modality for performing a host of operative procedures. The objective of this paper is to give a broad overview of laparoscopic surgery, to include: (1) patient positioning and how this aids surgery; (2) methods of establishing pneumoperitoneum, including the open Hassan and closed Veress needle techniques; (3) gas insufflation; (4) maintaining good vision during surgery and how this can be achieved; (5) insertion of additional ports; (6) a description of available laparoscopic instruments and their uses; (7) limitations of laparoscopy; and (8) closure of port sites. Despite its advantages, serious iatrogenic complications have been reported with laparoscopic surgery and the vast majority of these are avoidable. For this reason the paper places a particular emphasis on safety during laparoscopic surgery and steps that should be taken to ensure this.