Laparoscopic access with a visualizing trocar.
Although useful in most situations, there are several inherent disadvantages of the standard laparoscopic access techniques of Veress needle insertion and Hasson-type cannula placement. Veress needle placement may be hazardous in patients at high risk for intraabdominal adhesions and difficult in patients who are obese. The usual alternative, the Hasson-type cannula, often does not provide a good gas seal. As another option, the use of a visualizing trocar (OPTIVIEW) has proven to be effective in the initial experience at the University of Michigan. The inner trocar of the visualizing trocar is hollow except for a clear plastic conical tip with two external ridges. The trocar-cannula assembly is passed through tissue layers to enter the operative space under direct vision from a 10-mm zero-degree laparoscope placed into the trocar. Results suggest that this technique is an excellent alternative to Veress needle placement when laparoscopic access is likely to be hazardous or difficult.
Wolf
J S
JS
Section of Urology, Michigan Center for Minimally Invasive Urology, University of Michigan, Ann Arbor 48109-0330, USA.
D000007:Abdominal Injuries / Q000209:etiology; D000009:Abdominal Muscles / Q000601:surgery; D000328:Adult; D002404:Catheterization / Q000295:instrumentation; D003108:Colonic Diseases / Q000150:complications; D004867:Equipment Design; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007674:Kidney Diseases / Q000601:surgery; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009339:Needles; D009765:Obesity / Q000150:complications; D011471:Prostatic Neoplasms / Q000601:surgery; D011677:Punctures; D012307:Risk Factors; D000267:Tissue Adhesions / Q000150:complications