title: Direct visual or blind insertion of the primary trocar.
abstract: BACKGROUND
  We set out to assess the difference in complication rates between primary umbilical insertion by a blind trocar and insertion with an optical surgical obturator.
  
  
  METHODS
  In a retrospective survey, we investigated the rate of severe complications by primary umbilical trocar entry. Of 1546 patients undergoing gynecological laparoscopies at a tertiary-care university hospital, 1000 cases were operated by blind umbilical insertion with a conventional primary trocar whereas 546 used an optical primary trocar.
  
  
  RESULTS
  The rate of major complications during insertion of the primary trocar in the blind insertion group was five of 1000 (0.5%), whereas there were no major complications in the optical-guided insertion group (0.0%).
  
  
  CONCLUSIONS
  In comparison with the blind insertion of a sharp trocar, optical guidance provides a safe and functional primary insertion method that allows to detect adhesions to be detected at an early stage, thus preventing injuries to the bowel and abdominal vessels.
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital of Vienna, Wahringer Gürtel 18-20, 1090 Vienna, Austria.
authors.forename: S
authors.initials: S
authors.lastname: Jirecek
authors.forename: M
authors.initials: M
authors.lastname: Dräger
authors.forename: H
authors.initials: H
authors.lastname: Leitich
authors.forename: F
authors.initials: F
authors.lastname: Nagele
authors.forename: R
authors.initials: R
authors.lastname: Wenzl
mesh_terms: D000328:Adult; D003625:Data Collection; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D020706:Laparoscopes; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods; D014472:Umbilicus / Q000601:surgery; D020535:Video-Assisted Surgery / Q000295:instrumentation / Q000379:methods