Direct trocar insertion technique for initial access in morbid obesity surgery: Technique and results

Altun H., BANLI O., Karakoyun R., Boyuk A., Okuducu M., Onur E., ...More

Surgical Laparoscopy, Endoscopy and Percutaneous Techniques, vol.20, no.4, pp.228-230, 2010 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 20 Issue: 4
  • Publication Date: 2010
  • Doi Number: 10.1097/sle.0b013e3181ec6667
  • Journal Name: Surgical Laparoscopy, Endoscopy and Percutaneous Techniques
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.228-230
  • Keywords: laparoscopy, morbid obesity, pneumoperitoneum, direct trocar insertion, complications, VERESS NEEDLE INSERTION, LAPAROSCOPIC ENTRY, OPTICAL TROCAR, COMPLICATIONS, PNEUMOPERITONEUM, PLACEMENT, SAFETY
  • Lokman Hekim University Affiliated: Yes


Purpose: Obtaining access to the peritoneal cavity in laparoscopic surgery is more difficult in morbidly obese patients. There is no clear consensus as to the optimal method of entry into the peritoneal cavity. This study assesses the safety and feasibility of the direct trocar insertion technique without pre-existing pneumoperitoneum in patients undergoing laparoscopic bariatric surgery. Methods: From February 2006 to July 2009, 155 morbidly obese patients underwent laparoscopic adjustable gastric band surgery. There were 128 women (82.6%) and 27 men (17.4%). The mean age was 41 and ranged between 18 and 59 years. Results: All patients met the National Institutes of Health criteria for bariatric surgery. The mean body mass index was 45kg/m (range 35 to 61). There was no evidence of intestinal or vascular injury during trocar placement. Immediate minor complications were extraperitoneal insufflations in 5 patients, gastric serosal laceration in 1 patient, and left liver lobe laceration in 1 patient. No major complications were associated with this technique. Conclusions: All complications related to the direct trocar insertion technique were minor and these complications did not affect the success of surgery. We concluded that the direct trocar technique for initial access in laparoscopic bariatric surgery provides safe and quick entry into the peritoneal cavity. Copyright © 2010 by Lippincott Williams & Wilkins.