What is the proper technique for performing the Hasson (open) method for laparoscopic surgery?

From the Guidelines

I strongly recommend watching high-quality instructional videos on the Hasson technique for laparoscopic surgery from reputable medical education platforms, such as those endorsed by the American College of Obstetricians and Gynecologists (ACOG) or the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), to ensure proper technique and minimize complications. The Hasson technique, also known as the open laparoscopy technique, involves making a small incision (typically 1-2 cm) at the umbilicus, followed by blunt dissection through the subcutaneous tissue to expose the fascia. The surgeon then places stay sutures on the fascia, makes a small incision in it, and directly visualizes entry into the peritoneal cavity. A specialized Hasson cannula with a blunt tip is inserted under direct vision, and the stay sutures are secured to the cannula to create an airtight seal. This technique was developed to reduce the risk of vascular and bowel injuries that can occur with blind trocar insertion methods. The Hasson technique is particularly valuable in patients with previous abdominal surgeries, obesity, or when adhesions are suspected, as noted in the 2023 study by Cathcart et al. 1.

Some key considerations for the Hasson technique include:

• Initial access can be safely achieved via open (Hasson) technique, which may reduce the risk of uterine trauma or spillage of ovarian cysts 1
• Uterine size should be determined by palpation or ultrasound to guide port placement 1
• CO2 insufflation pressure should be adjusted to the patient’s physiology, with an initial insufflation pressure of 20-25 mm Hg and an operating pressure of 12 mm Hg 1
• Intraoperative CO2 monitoring by capnography should be used to avoid maternal hypo- and hypercapnia 1

To properly learn the Hasson technique, it's essential to observe the proper handling of instruments, tissue manipulation, and cannula placement, which is best demonstrated through video instruction followed by supervised practice. Additionally, the 2021 study by the World Journal of Emergency Surgery 1 highlights the importance of minimizing OR air contamination, reducing pneumoperitoneum pressure, and avoiding long dissecting times to reduce surgical smoke. By following these guidelines and watching high-quality instructional videos, surgeons can master the Hasson technique and improve patient outcomes.

From the Research

Overview of the Hasson Technique

• The Hasson technique is a method used to establish pneumoperitoneum in laparoscopic surgery, first described by Hasson in 1970 2.
• This technique involves creating a small umbilical incision under direct visualization to enter the abdominal cavity, followed by the introduction of a blunt trocar.
• The benefits of the Hasson technique include the avoidance of blind insertion of the Veress needle and bladed trocar, prevention of visceral and vascular injuries, and guaranteed pneumoperitoneum 2.

Comparison with the Veress Technique

• The Veress technique is a closed method that involves the blind insertion of the Veress needle into the peritoneal cavity 3, 4.
• Studies have compared the safety and efficacy of the Hasson and Veress techniques, with some finding that the Hasson technique is a quicker method for creating pneumoperitoneum 3.
• Other studies have found that both techniques are safe and effective, with no significant difference in complication rates 5, 6.

Key Points to Consider

• The Hasson technique is considered a safer method for establishing pneumoperitoneum, especially in patients with previous abdominal surgery 5.
• The Veress technique is still widely used and can be safe when performed properly, but it carries a risk of visceral and vascular damage 6.
• The choice of technique ultimately depends on the surgeon's preference and experience, as well as the individual patient's needs and circumstances.

Steps Involved in the Hasson Technique

• Create a small umbilical incision under direct visualization to enter the abdominal cavity.
• Introduce a blunt trocar into the incision.
• Establish pneumoperitoneum by insufflating gas into the abdominal cavity.
• Insert additional trocars and instruments as needed to complete the laparoscopic procedure.

Video Demonstration

• A video demonstration of the Hasson technique can be a useful tool for surgeons to learn and master the technique.
• The video should show the step-by-step process of creating the umbilical incision, introducing the trocar, and establishing pneumoperitoneum.
• It is essential to note that the video should be used in conjunction with hands-on training and experience to ensure proficiency in the technique.