title: 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.
authors.affiliation: Department of Gynecology and Obstetrics, Ankara Research and Training Hospital, Ankara, Turkey.
authors.forename: Mustafa Ziya
authors.initials: MZ
authors.lastname: Günenç
authors.forename: Narter
authors.initials: N
authors.lastname: Yesildaglar
authors.forename: Banu
authors.initials: B
authors.lastname: Bingöl
authors.forename: Goksen
authors.initials: G
authors.lastname: Onalan
authors.forename: Selcuk
authors.initials: S
authors.lastname: Tabak
authors.forename: Bulent
authors.initials: B
authors.lastname: Gökmen
mesh_terms: D004066:Digestive System Diseases / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D011446:Prospective Studies; D017568:Rectus Abdominis / Q000601:surgery*; D012449:Safety; D013525:Surgical Instruments; D016896:Treatment Outcome