Minimizing Risk of Retroperitoneal Major Vascular Injury with Abdominal Wall Elevation Device during Abdominal Entry for Laparoscopic and Robotic Surgery.

Objective: Retrospective clinical report to demonstrate the use of abdominal wall elevation device with closed technique direct entry with 3-mm port. Design: An abdominal wall elevation device (LevaLap 1.0) was used during abdominal entry for laparoscopic and robotic gynecologic procedures. The primary outcomes were major vascular or visceral injury. Other events assessed included number of entry attempts, failed entry, and adverse events during entry. Descriptive statistics were used to characterize the patient population and the incidence of abdominal entry injuries or events. Setting: Tertiary hospital. Patients: Female patients undergoing laparoscopic gynecologic procedures with or without robotic assistance using an abdominal wall elevation device with direct entry technique from July 2023 to May 2024. Exclusion criteria were patients less than 18 years of age. Interventions: Use of abdominal elevation device at initial entry. Measurements and Main Results: The elevation device was used in 25 patients with a 3-mm direct trocar. Entry was achieved on the first attempt in all cases. There were no major vascular, visceral injuries, or failed entry events. Conclusion: Use of a device to elevate the abdominal wall in a standardized fashion is feasible with direct entry using 3-mm port may help reduce the risk of retroperitoneal major vascular injury; however, larger comparative studies are required to confirm efficacy.