Direct trocar access: a safe method to create pneumo peritoneum, experience from GI and minimal access surgery unit, RIMS, Imphal

Sreejith V.; Yepeto Lohe; Vidyanand Tripathi; Arshad Ansari; Angela B. Marak; G. S. Moirangthem

doi:10.18203/2349-2902.isj20191059

Authors

Sreejith V. Department of General Surgery, Regional Institute of Medical Sciences, Imphal, Manipur, India
Yepeto Lohe Department of General Surgery, Regional Institute of Medical Sciences, Imphal, Manipur, India
Vidyanand Tripathi Department of General Surgery, Regional Institute of Medical Sciences, Imphal, Manipur, India
Arshad Ansari Department of General Surgery, Regional Institute of Medical Sciences, Imphal, Manipur, India
Angela B. Marak Department of General Surgery, Regional Institute of Medical Sciences, Imphal, Manipur, India
G. S. Moirangthem Department of General Surgery, Regional Institute of Medical Sciences, Imphal, Manipur, India

DOI:

https://doi.org/10.18203/2349-2902.isj20191059

Keywords:

Direct trocar insertion, Laparoscopy procedure, Open technique, Pneumoperitoneum, Veress needle

Abstract

Background: The establishment of pneumoperitoneum is a prerequisite for all laparoscopic surgeries. The standard techniques of creating pneumoperitoneum are open and closed technique. Recent studies showed, complications associated with Veress needle insufflation such as gas embolism, sub cutaneous emphysema etc. Hasson’s method has shown to minimise vascular injuries but doesn’t reduce bowel injuries along with gas leak and port instability. The present study was conducted to assess the safety and efficacy of direct trocar insertion in patients undergoing elective laparoscopic procedures.

Methods: The present study was conducted prospectively on 476 patients undergone various laparoscopic abdominal procedures using direct trocar access to create pneumo peritoneum during a period from May 2014 to July 2017 in unit 1 of Department of Surgery, RIMS, Imphal, India.

Results: All patients age varying from 14 to 70 years are included. The average time taken from skin incision to create pneumoperitoneum was 1 mt. However, author is unable to use this technique in 4 patients having central obesity and switched on to conventional Veress needle for creating pneumoperitoneum. No injuries to bowel, vessels and other insufflation related complication were encountered.

Conclusions: No technical difficulty was encountered while inserting trocar directly. No intra-abdominal injuries of bowel, mesentery or vessel were detected. Intra operatively all patients were found to be stable hemodynamically. Post-operatively and on follow up no port site complication such as infection, granuloma formation, induration and herniation were encountered.

Metrics

Metrics Loading ...

Author Biography

Sreejith V., Department of General Surgery, Regional Institute of Medical Sciences, Imphal, Manipur, India

Post graduate trainee, General Surgery

References

Mintz M. Risks and prophylaxis in laparoscopy: a survey of 100000 cases. J Repro Med. 1977;18(5):269-72.

Cunanan JR, Courey NG, Lippes JA. Complications of laparoscopic tubal sterilization. Obstetrics Gynecol. 1980;55(4):501-6.

Hasson HM. A modified instrument and method laparoscopy. Am J Obstetrics Gynecol. 1971;110(6):886-7.

Dingfelder JR. Direct laparoscope trocar insertion without prior pneumoperitoneum. J Reproductive Med. 1978;21(1):45-7.

Copeland C, Wing R, Hulka JF. Direct trocar insertion at laparoscopy: an evaluation. Obstetrics Gynecol. 1983;62(5):655-9.

Byron JW, Fujiyoshi CA, Miyazawa K. Evaluation of the direct trocar insertion technique at laparoscopy. Obstetrics Gynecol. 1989;74(3):423-5.

Vilos GA, Ternamian A, Dempster J, Laberge PY, Vilos G, Lefebvre G, et al. Laparoscopic entry: a review of techniques, technologies, and complications. J Obstetrics Gynaecol Can. 2007;29(5):433-47.

Harrell AG, Heniford BT. Minimally invasive abdominal surgery: lux et veritas past, present, and future. Am J Surg. 2005;190(2):239-43.

Jansen FW, Kolkman W, Bakkum EA, Kroon CD, Trimbos-Kemper TC, Trimbos JB. Complications of laparoscopy: an inquiry about closed-versus open-entry technique. Am J Obstetrics Gynecol. 2004;190(3):634-8.

Yuzpe AA. Pneumoperitoneum needle and trocar injuries in laparoscopy. a survey on possible contributing factors and prevention. J Reproductive Med. 1990;35(5):485-90.

Garry R. Towards evidence‐based laparoscopic entry techniques: clinical problems and dilemmas. Gynaecol Endosc. 1999;8(6):315-26.

Lalchandani S, Phillips K. Laparoscopic entry technique-a survey of practices of consultant gynaecologists. Gynecol Surg. 2005;2(4):245.

Volpi E, Sismondi P. Semi‐open direct trocar insertion method for induction of pneumoperitoneum at laparoscopy. Gynaecol Endosc. 2002;11(4):197-200.

Byron JW, Markenson G, Miyazawa K. A randomized comparison of Verres needle and direct trocar insertion for laparoscopy. Surg Gynecol Obstetrics. 1993;177(3):259-62.

Yerdel MA, Karayalcin K, Koyuncu A, Akin B, Koksoy C, Turkcapar AG, et al. Direct trocar insertion versus Veress needle insertion in laparoscopic cholecystectomy. Am J Surg. 1999;177(3):247-9.

Kaloo P, Cooper M, Reid G. A prospective multicentre study of laparoscopic complications related to the direct‐entry technique. Gynaecol Endosc. 2002;11(2‐3):67-70.

Inan A, Sen M, Dener C, Bozer M. Comparison of direct trocar and veress needle insertion in the performance of pneumoperitoneum in laparoscopic cholecystectomy. Acta Chirurgica Belgica. 2005;105(5):515-8.

Prieto-Díaz-Chávez E, Medina-Chávez JL, González-Ojeda A, Anaya-Prado R, Trujillo-Hernández B, Vásquez C. Direct trocar insertion without pneumoperitoneum and the Veress needle in laparoscopic cholecystectomy: a comparative study. Acta Chirurgica Belgica. 2006;106(5):541-4.

Lal P, Sharma R, Chander J, Ramteke VK. A technique for open trocar placement in laparoscopic surgery using the umbilical cicatrix tube. Surg Endosc Interventional Tech. 2002;16(9):1366-70.

Borgatta L, Gruss L, Barad D, Kaali SG. Direct trocar insertion vs. Verres needle use for laparoscopic sterilization. J Reproductive Med. 1990;35(9):891-4.

Byron JW, Markenson G, Miyazawa K. A randomized comparison of Verres needle and direct trocar insertion for laparoscopy. Surg Gynecol Obstetrics. 1993;177(3):259-62.

Soomro AH. Creation of pneumoperitoneum by a new technique prior to laparoscopic procedure. J Liaquat Uni Med Heal Sci. 2004;3(1):18-21.

Hasson HM. A modified instrument and method laparoscopy. Am J Obstetrics Gynecol. 1971;110(6):886-7.

Champault G, Cazacu F, Taffinder N :Serious trocar accidents in laparoscopic surgery: a French survey of 103852 operations. Surg Laparosc Endosc 1996;6:367–70.

Cogliandolo A, Manganaro T, Saitta FP, Micali B. Blind versus open approach to laparoscopic cholecystectomy: a randomized study. Surg Laparoscopy Endosc. 1998;8(5):353-5.

Günenç MZ, Yesildaglar N, Bingöl B, Önalan G, Tabak S, Gökmen B. The safety and efficacy of direct trocar insertion with elevation of the rectus sheath instead of the skin for pneumoperitoneum. Surg Laparosc Endosc Percutaneous Tech. 2005;15(2):80-1.