Comparison of the Outcomes of Direct Trocar Insertion with Modified Open Entry in Laparoscopic Surgery

Introduction. Initial trocar entry, the first step in laparoscopic surgery, is associated with several complications. In morbidly obese patients, initial trocar placement is associated with a greater number of complications compared to non-obese patients. Materials and Surgical Technique. In this study, we describe our use of an initial trocar entry technique which is direct trocar insertion with elevation of the rectus sheath by a single Backhaus towel clamp and we would like to evaluate the sa fety and efficacy of its administration in bariatric surgery. Discussion. Our results indicate that gaining initial trocar entry using our technique leads to successful laparoscopic bariatric surgery. Our technique is a safe, effective, and reliable first step in successful laparoscopic surgery for almost all patients, and is only contraindicated in patients with severe hepatomegaly.

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Direct trocar insertion without the pneumoperitoneum in laparoscopic surgery - Is this a safe technique?

Hellenic Journal of Surgery ◽

10.1007/s13126-015-0248-8 ◽

2015 ◽

Vol 87 (5) ◽

pp. 415-418 ◽

Cited By ~ 3

Author(s):

Rajesh Godara ◽

A. R. Bansal ◽

Surender Verma ◽

Sunil Yadav ◽

Naveen Verma ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Trocar Insertion ◽

Direct Trocar Insertion ◽

Safe Technique

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Randomised study to compare direct trocar insertion and Veress needle technique for creation of pneumoperitoneum in laparoscopic surgery

International Journal of Surgery and Medicine ◽

10.5455/ijsm.direct-trocar-insertion-veress-pneumoperitoneum ◽

2018 ◽

Vol 4 (3) ◽

pp. 1

Author(s):

Rajesh Godara ◽

Vikas Verma ◽

Ashish Anand ◽

Anil Mehta

Keyword(s):

Laparoscopic Surgery ◽

Veress Needle ◽

Randomised Study ◽

Trocar Insertion ◽

Needle Technique ◽

Direct Trocar Insertion

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Comparison of Complications between Direct Trocar Insertion Versus Veress Needle for Creation of Pneumoperitoneum in Patients Undergoing laparoscopic Cholecystectomy: A Randomized Control Trial

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i40a32247 ◽

2021 ◽

pp. 294-299

Author(s):

Kamran Hamid ◽

Shabbir Ahmad ◽

Bahzad Akram Khan ◽

Muhammad Faheem Answer ◽

Amer Latif ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Needle Insertion ◽

Veress Needle ◽

P Value ◽

Surgical Department ◽

Trocar Insertion ◽

Laparoscopic Entry ◽

Significant Difference ◽

Duration Of Surgery ◽

Direct Trocar Insertion

Aim: To compare the outcomes in term of complication of Veress Needle Insertion (VNI) to Direct Trocar Insertion (DTI) for creation of pneumoperitoneum in laparoscopic cholecystectomy. Design: Randomized controlled trial Place and Duration of Study: The current analysis was conducted at Khawaja Muhammad Safdar Medical College Surgical Department, Allama Iqbal Memorial Hospital and Govt. Sardar Begum Teaching Hospital, Sialkot from September 27, 2017, to September 26, 2020. Methodology: A total of six hundred and eight (n=608) patients, having age 30 to 75 years planned for laparoscopic cholecystectomy were included in this study. Patients were randomly divided into two groups, Group A (Direct Trocar Insertion), Group B (Veress Needle Insertion). Both groups had age and sex matched males and female. All trocars and veress needle used were disposable, with a safety shield. The primary outcome of our study was to compare the complications to assess the safety levels, while total time taken by the procedure and mean time for laparoscopic entry were the secondary end points. The collected data was analyzed by using software SPSS version 22. Chi-square test was used to check the significance of variance. P-value less than 0.05 remained the statistically significant. Results: The complication rate in VNI group were significantly greater than the DTI group (p < 0.01), the duration of surgery between the two groups was not significantly different (p > 0.05), but we found statistically significant difference in mean laparoscope insertion time (DTI 3.4+ 1.4 versus VNI 4.8+ 0.7 minutes, p < 0.001). Conclusion: From the results of our study, it can be concluded that the direct trocar insertion is a safe alternative to veress needle insertion in laparoscopic cholecystectomy as it is associated with fewer complications.

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Principles and Techniques of Abdominal Access and Physiology of Pneumoperitoneum

10.2310/vasc.2203 ◽

2018 ◽

Author(s):

Jon C. Gould ◽

Kathleen Simon

Keyword(s):

Laparoscopic Surgery ◽

Incisional Hernia ◽

Vascular Injury ◽

Air Embolism ◽

Recent Time ◽

Abdominal Pressure ◽

Visceral Injury ◽

Respiratory Effects ◽

Trocar Insertion ◽

Port Site Hernia

Laparoscopic surgery has gained popularity in recent time. An essential aspect of this technique is production of a pneumoperitoneum with insufflation for adequate visualization and manipulation of abdominal contents. Various techniques have been developed over the years for optimal access with minimization of complications. Some of these complications include vascular injury, visceral injury, and incisional hernia. Furthermore, considerations with regards to the patient’s physical morphology, and the cardiovascular/respiratory effects of increased abdominal pressure and anesthesia must be accounted for. The guidelines to optimize patient care in these regards are discussed in this review. This review contains 2 videos, 5 figures, 2 tables, and 79 references. Keywords: trocar insertion, port site hernia, Veress needle, optical trocar, trocar related injuries, Hassan cannula, pneumoperitoneum, air embolism, pneumoperitoneum physiology

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