title: Initial trocar placement and abdominal insufflation in laparoscopic bariatric surgery.
abstract: BACKGROUND
  Initial trocar placement and abdominal insufflation in laparoscopic bariatric surgery can be challenging for the novice. One technique is the use of an optical viewing trocar without prior abdominal insufflation. This investigation tests the hypothesis that this technique can be taught to novice surgeons with good results.
  
  
  METHODS
  Patients undergoing laparoscopic bariatric surgery were included. Novice surgeons (residents/fellows) with 0-50 initial trocar placements placed the initial trocar and insufflated the abdomen in the presence of an expert surgeon (>300 initial trocar placements in morbidly obese patients). Trocar placement time was defined as the time to place the trocar into the peritoneal cavity (including infiltration of local anesthesia and incision). Insufflation time was defined as the time to insufflate the abdomen to a pressure of 10 to 15 mm Hg (including time to place tubing on trocar). Novice times were compared with expert times.
  
  
  RESULTS
  There were 81 patients (56 by expert and 25 by novice) in this study. No bowel or vessel injury during initial trocar placement was noted. No correlation was seen between times and BMI or waist/hip circumference (P = NS). Mean expert trocar placement time was shorter than the mean novice time (25 +/- 9 versus 54 +/- 27 s; P < 0.0001); although there was no difference in mean insufflation time (expert versus novice: 16 +/- 5 versus 19 +/- 10; P = NS). The mean total time to place the initial trocar and insufflate the abdomen for the novices was 72 +/- 26 s.
  
  
  CONCLUSIONS
  Initial trocar placement can be taught safely to novices. The technique using an optical viewing trocar without prior abdominal insufflation is effective and efficient in morbidly obese patients.
authors.affiliation: Minimally Invasive Surgery Section, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA. amadan@utmem.edu
authors.forename: Atul K
authors.initials: AK
authors.lastname: Madan
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Taddeucci
authors.forename: Jason L
authors.initials: JL
authors.lastname: Harper
authors.forename: David S
authors.initials: DS
authors.lastname: Tichansky
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000295:instrumentation / Q000379:methods*; D002983:Clinical Competence; D003162:Competency-Based Education / Q000379:methods; D004502:Education, Medical, Continuing / Q000379:methods; D006801:Humans; D007327:Insufflation / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D013525:Surgical Instruments