Direct trocar insertion without prior pneumoperitoneum

Abstract EN

Objective: The direct trocar insertion (DTI) technique has been described as an alternative method to Veress needle (VN) technique.

This study assess the safety and feasibility of DTI without pre-existing pneumoperitoneum in patients undergoing elective laparoscopic procedures.

Methods: From January 2011 till November 2012, 140 patients were prospectively evaluated.

Seventy patients underwent VN technique of entry to the abdomen, while the other 70 patients underwent DTI technique.

Females were 115 and males were 25, age range was 17-76 years.

The technique adopted for DTI was through umbilical skin incision, elevation of the abdominal wall with the grip of the surgeon's non-dominant hand and the grip of the assistant hand with direct entry of a 10 mm reusable trocar by the surgeon's dominant hand with a balanced counter traction to prevent any possible overshoot, while those who underwent Veress needle technique have same umbilical incision through which the Veress needle was introduced first with the aid of abdominal wall elevation followed by CO2 insuflation and then introduction of the 10 mm port by the same way described above.

Major and minor injuries and complications related to both access techniques were observed and the time needed for entry to the abdomen (from skin incision till the introduction of the telescope) was recorded for all patients in both groups.

Results: Direct trocar insertion was feasible in all the 70 patients subjected to this technique, no associated major complications.

The immediate minor complications occurred in 32 (45.7%) patients of VN group and in 7 (10%) patients of DTI group, this difference is statistically significant (p<0.001).

The mean time required for entry to the abdomen was 3.63±0.64 minutes in VN group and 1.79±2.39 minutes in DTI group.

This difference is also statistically significant (p<0.001).

Conclusions: We concluded that DTI of the first trocar without prior pneumoperitoneum in elective laparoscopy is a fast, safe and feasible alternative procedure to VN with a fewer minor complications.