Open and Close Laparoscopic Access

This chapter describes the two different techniques of access to the abdominal cavity for minimally invasive (laparoscopic and robotic) surgery: the open technique, which involves the insertion of the first cannula (trocar) under direct vision, and the closed technique, which involves the insertion of the first cannula without direct vision. Different modalities of open and closed techniques have been described, but literature does not affirm the superiority of one technique over another in terms of patients’ mortality or major and minor complications. Moreover, different trocar types are available for usage in minimally invasive surgery, and superiority of one over the others has not been established. Finally, the chapter describes the effects of pneumoperitoneum and its possible consequences on the cardiovascular, respiratory, and central nervous systems.