Rethinking Direct Trocar Insertion for Laparoscopic Entry: Lessons from Nine Litigated Cases

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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Pneumoperitoneum Creation for Laparoscopic Entry: Veress Needle Insertion Technique Versus Direct Trocar Insertion Technique: A Prospective Comparative Study

New Indian Journal of Surgery ◽

10.21088/nijs.0976.4747.9118.17 ◽

2018 ◽

Vol 9 (1) ◽

pp. 88-92

Author(s):

Vidyanendh Vijayalakshmi ◽

◽

Sambandam Murugan Raghunath ◽

Keyword(s):

Comparative Study ◽

Needle Insertion ◽

Veress Needle ◽

Insertion Technique ◽

Trocar Insertion ◽

Laparoscopic Entry ◽

Direct Trocar Insertion ◽

Prospective Comparative Study

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Native Umbilical Defect for Laparoscopic Entry

Annals of African Surgery ◽

10.4314/aas.v17i3.6 ◽

2020 ◽

Vol 17 (3) ◽

Author(s):

Tarek Osama Hegazy ◽

Mohamed Hassan Ali ◽

Ahmed Amr Mohsen ◽

Mahmoud Azhary ◽

Ahmad Yahia Abdel Dayem

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Native Defect ◽

Open Technique ◽

Entry Site ◽

Native Defects ◽

Umbilical Incision ◽

Trocar Insertion ◽

Laparoscopic Entry ◽

Direct Trocar Insertion

Background: The presence of defects in native umbilical in adults and its use as laparoscopic first entry site is poorly documented. It would likely be a safer method than the Veress needle and direct trocar insertion. This work aimed to report the prevalence and size of native umbilical defects, and their relationship with gender, age and body mass index. Methods: In 160 consecutive laparoscopic operations, a trans-umbilical incision was made and a defect at its base was looked for. When found, the defect was measured and used as the first port entry site. Relationships of presence of native defects and their sizes in relation to gender, age and BMI were analyzed. Results: The prevalence of a native defect in this series was 90%. Its presence had no relation with gender, age or BMI. Its size, however, positively correlated with age and BMI. No complications were related to the defect’s use for first laparoscopic entry site. Conclusion: A native umbilical defect is present in 90% of adults. Whenever present, it is recommended for use as the first port entry site by an open technique. This method is simple and safe and avoids unnecessarily inducing another defect. Keywords: Laparoscopy, Open technique, Access, Native defect, Umbilical defect

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Safety of Direct Trocar Entry in Laparoscopy in a Structured Fellowship Programme

International Journal of Human and Health Sciences (IJHHS) ◽

10.31344/ijhhs.v4i1.119 ◽

2019 ◽

Vol 4 (1) ◽

pp. 51

Author(s):

Nikita Trehan ◽

Hafeez Rehman Padiyath ◽

Amanjot Kaur ◽

Mansi Dhingra ◽

Rashmi Shriya ◽

...

Keyword(s):

Complication Rate ◽

Needle Insertion ◽

Trocar Insertion ◽

Laparoscopic Entry ◽

Fellowship Programme ◽

Prior Surgery ◽

Direct Trocar Insertion ◽

History Of ◽

Degree Of Confidence ◽

Laparoscopic Experience

Introduction:The best method of primary trocar insertion in laparoscopy remains controversial. There are advocates for both initial Veress needle insertion as well as direct trocar insertion.Aim of the study: This study was carried out to find out the complication rate of direct trocar insertion as a method of laparoscopic entry and find out the learning curve of trainees in a structured fellowship programme.Methodology: Retrospective analysis was done over period of 5 years with a sample size of 2053 subjects.Results: 2053 laparoscopic surgeries were examined. Overall complication rate was 0.38%; subjects with previous abdominal surgery were found to have higher complication rate as compared to ones with no history of prior surgery. [0.46% and 0.35% respectively]. All trainees gained reasonable degree of confidence within 6 months.Conclusion: Direct trocar insertion is a safe method of laparoscopic entry, which can be taught to trainees with no prior laparoscopic experience, without an increase in entry complications.International Journal of Human and Health Sciences Vol. 04 No. 01 January’20 Page : 51-54

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