Direct Trocar Insertion in Gynecological Laparoscopy; A Case Series of 300 Cases

Abstract

Background: Laparoscopy is a diagnostic and surgical procedure used in all surgical disciplines.The rationale for DTI, without prior pneumoperitoneum, is based on the difficulty of grasping and lifting the abdomen after it is distended with gas and the fact that the VN accounts for many complications. It was noted that complications of laparoscopic surgery are mostly entry-related and independent of the complexity of surgery. DTI without pneumoperitoneum was reported to be associated with minimal complications and preferred by some laparoscopic surgeons. Objective:The study aimed to evaluate the patients who will undergo a DTI for laparoscopy, focusing attention on feasibility, safety, benefits and risks of DTI. We also want to discuss some technical aspects, such as the site of the trocar insertion. Patients and Methods:A prospective cohort study had been carried out in El-Galaa Teaching Hospital during the period between August 2015 and December 2019.Three hundred gynecological patients admitted for either scheduled or emergency laparoscopy. The following methods were done: Direct trocar insertion during laparoscopy had been the standard entry for all selected cases without prior pneumoperitoneum. The entry had been performed at the umbilical level.Results: successful pneumoperitoneum was established in 100% patients irrespective of previous surgery, BMI, parity. Mean time to induce pneumoperitoneum was 100.6±19.27 seconds in all patients. 10 patients had a minor omental injury as there was 10 (3.3%) omental adhesions to anterior abdominal wall due to previous surgery. These injuries were very small and managed by laparoscopy. Conclusion:DTI is a very safe and reliable technique for creation of pneumoperitoneum, and should be used routinely instead of closed Veress needle technique.

Systematic review and meta-analysis of Veress needle entry versus direct trocar entry in gynecologic surgery

“…Both techniques have generally favorable complication profiles. Possible complications for both DTI and VN include surgical site infection, omental injury or extraperitoneal insufflation 11. Recent studies have suggested that DTI is safer and faster than the VN entry technique, but the largest meta analyses to date have not found clinical significance between these two techniques 12–14…”