Menopause: The Journal of The North American Menopause Society Voi, 16, No. 5, pp. 966-970 DOI: I0.i097/gme.0b013e3181a037ed © 2009 by The North American Menopause Society Initial laparoscopie access in postmenopausal women: a preliminary prospective study Andrea Tinelli, Affi)/ Antonio Malvasi, MD,2 Marcella Guido, PhD,3 Olav Istre, MD, PhD,4 Joerg Keckstein, MD, PhD,5 and Liselotte Mettler, MD, PhD6 Abstract Objectìve: Estrogen loss at menopause has a profound influence on skin, with postmenopausal atrophy and loss of tone and elasticity. Because more than 50% of major laparoscopie complications occur during initial entry under thè abdominal skin, thè efficacy and thè safety of two laparoscopie access techniques were compared in postmenopausal women. Methods: One hundred eighty-six postmenopausal women underwent laparoscopie surgery for simple ovarian cysts: 89 were assigned to direct optìcal access (DOA), abdominal entry (group I), and 97 to thè classic closed Veress needle approach, pneumoperitoneum, and trocar entry (group II). The following parameters were compared: rime needed for entry into thè abdomen, occurrence of vascular and/or bowel injury, and blood loss. Results were analyzed using SAS software, considering P value less than 0.05 as significant. Results: No statistìcally significant difFerences were observed in thè occurrence of major vascular and/or bowel injury between thè two techniques (P > 0.05), whereas time for abdominal entry was significantly reduced in thè DOA group, as well as thè occurrence of minor vascular injuries (P < 0.05). Conctusions: Results of this preliminary comparison on tìie DOA and thè Veress methods, commonly used by gynecologists, suggest that thè visual entry System offers a statistical advantage over thè closed Veress needle approach, in terms of time saving and limiting minor vascular injuries, thus enabling a safe and fasi visually guided entry in postmenopausal women. Key Words: Menopause - Gynecological laparoscopy - Initial abdominal access - Skin aging - Direct optìcal access - Veress needle —Estrogen. P hysiological changes occur with aging in ali organ systems of thè female body, particularly on thè skin. Estrogens affect several skin functions, such as hair growth, pigmentation, vascularity, elasticity, and water- holding capacity, thus influencing skin thickness, wrinkling, and moisture. The epidermis of thè skin atrophies with age and lean body mass declines, primarily due to loss and atrophy of muscle cells. The relevant hypoestrogenism accompanying menopause exacerbates thè deleterious effects of botii intrìnsic and Received November 24, 2008; revised and accepted February 5, 2009. From thè 'Department of Obstetrics and Gynaecology, Vita Pazzi Hospital, Lecce; 2Depaitment of Obstetrics and Gjraeoofcgy, Santa Maria Hospital, Bari; 'Department of Biologica! and Enviiuomental Sciences and Technologies, Laboratoiy of Hygjene, Unirersity of Salente. Lecce, Italy; 4Depanment of Gynaecotogy and Obstetrics, Ulkvaal University Hospital, Kirkeveien, Oslo, Norway; ^Department of Obstetrics and Gynaecotogy, LandesKrankenHouse, Villach, Austria; and 'Depart- ment of Obstetrics and Gynaecology, Kiel School of Gynecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Germany. Financial disclosure/conflicts of interest: None reported. Address reprint requests to: Andrea Tinelli, MD, Department of Obstetrics and Gynecology, Vtto Pazzi Hospital, Piazza Muratore, 73100 Lecce, Italy. E-mail: andFeatinelli@gtnail.com 966 Menopause, Voi 16, No. 5, 2009 environmental aging, especially on thè cutis, where they have clearly played a key role in skin aging homeostasis, as observed in perimcnopausal years.' Among thè postmenopausal skin changes, hypoestrogen- ism promotes a collagen drop and a decrease in both elasrin content and skin thickness; collagen atrophy is, in fact, a major factor in skin aging, associated with a progressive increase in extensibility and a reduction in elasticity. This makes thè skin more fragile and susceptible to trauma, leading to more lacerations and bruising and wound healing impairment in older women.2 Changes in skin characteristìcs might, therefore, influence thè initial laparoscopie abdominal access in postmenopausal women. Given that laparoscopie surgery is more advanta- geous than laparotomy for both women and gynecologists beoau.se of thè significantly reduced ovcrall risk of complica- tions, 3 more tfian 50% of major laparoscopie complieations actually occur during initial entry into thè female abdomen at any age. 3 ' 4 In fact, major vascular injury during initial laparo- scopie access is a major cause of death from laparoscopy, second only to anesthesia and bowel injury, with a reported mortality rate of 15%. 5 Several techniques and technologies have been introduced to minimize entry-related complications, which include many types of entry, namely, thè Veress insufflation needle Copyright © 2009 The North American Menopause Society. Unautnorized reproductiO'" of 'h'.s artide s prohiDMed.