The Safety and Efficacy of Direct Trocar Insertion With Elevation of the Rectus Sheath Instead of the Skin for Pneumoperitoneum

Abstract

Abdominal access in endoscopic surgery carries a finite risk of visceral injury. Bleeding, subcutaneous emphysema, gastrointestinal tract perforation, minor and major vascular injury, and intraperitoneal adhesions are the potential complications associated with abdominal access and creation of pneumoperitoneum. There are 4 basic techniques used to create pneumoperitoneum: blind Veress needle, direct trocar insertion, optical trocar insertion, and open laparoscopy. Veress needle and direct trocar insertion are blind techniques, and their use can result in severe visceral and vascular injuries. To prevent visceral and vascular injuries caused by the technique used for the creation of pneumoperitoneum, laparoscopic surgeons and gynecologists look for safe and effective laparoscopic access techniques. Direct trocar insertion without previous pneumoperitoneum was reported to be a safe alternative to Veress needle insertion. We carried out this study to compare the ease of use, safety, and efficacy of direct trocar insertion with elevation of the rectus sheath and blind insertion of the Veress needle in laparoscopic surgery. In 578 laparoscopic procedures, the patients were assigned to one of the following groups: blind insertion of the Veress needle (group 1, n = 301) and direct trocar insertion with elevation of the rectus sheath using 2 towel clips (group 2, n = 277). Total complication rates were 15.7% (n = 33) and 3.3% (n = 4) in groups 1 and 2, respectively (P< 0.05). Direct trocar insertion with elevation of the rectus sheath using 2 towel clips is an easy, safe, and effective technique.

A Randomized Controlled Trial Comparing Laparoscopic Access with the DTI and VNI

“…Similar findings were supported in studies performed by Günenç et al [12] and Zakherah, [13] who reported that the extraperitoneal insufflation is almost entirely a Veress needle entry-related complication. As a possible explanation of this situation, it is thought that failed and multiple insertions with the Veress needle presumably have led to extraperitoneal insufflation.…”

Comparison of two methods of laparoscopic trocar insertion (Hasson and Visiport) in terms of speed and complication in urologic surgery

“…Gunenj et al, in 2005 obtained same results and demonstrated that direct trocar insertion is an easy, safe, and effective technique [ 39 ]. Tinelli et al, in 2009 reported that optically guided trocars can reduce the danger of injury to abdominal construction which cause surgeon to observe abdominal wall layers in placement [ 28 ].…”

Laparoscopic Entry Using Direct First Trocar Insertion without a Prior Pneumoperitoneum: A Prospective Cohort Study

“…10 The DFTI technique was reported to be associated with low complication rates and is preferred by some laparoscopic surgeons. 11 The DFTI technique without a prior pneumoperitoneum for laparoscopic entry was first reported by Dingfelder in 1978. 12 The reported benefits of this technique are its short laparoscopic entry, short insufflations and operative times, ability to immediately recognize vascular and visceral injuries, minimal entry failure, and low carbon dioxide (CO 2 ) embolism.…”

“…Günenç et al 11 reported that VN and DFTI are blind techniques and can result in severe visceral and vascular injuries. To avoid such injuries, laparoscopic surgeons and gynecologists seek safe and effective laparoscopic access techniques.…”