title: Primary midline peritoneal access with optical trocar is safe and effective in morbidly obese patients.
abstract: BACKGROUND
  The bladed optical access trocar is widely used and provides convenient, safe peritoneal entry. However, it has only been approved for use after insufflation. We used this device as our primary method of entry before insufflation in bariatric surgery and provide an overview of our cumulative experience. In addition, we provide a comprehensive analysis of the published data with respect to optical access as both primary and secondary methods of peritoneal access.
  
  
  METHODS
  From July 30, 2001 to April 4, 2008, laparoscopic access for all bariatric surgery at a single center was achieved using the 5-12-mm optical bladed trocar without previous insufflation for 2207 cases, including 1692 laparoscopic gastric bypass procedures and 515 laparoscopic adjustable gastric band placements.
  
  
  RESULTS
  Four vascular injuries occurred (.18%) in our series. Three required conversion to laparotomy and vascular repair, and one was managed laparoscopically. All injuries occurred with off-midline placement. No mortalities occurred secondary to the use of the optical trocar.
  
  
  CONCLUSIONS
  The present report is as the greatest volume series detailing the safe and effective use of the bladed optical trocar without previous insufflation as the primary method of peritoneal access in the morbidly obese. The insertion of this device in the midline appears to be a safe method of entry.
authors.affiliation: Center for Minimally Invasive and Bariatric Surgery, Department of Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA.
authors.forename: Nari
authors.initials: N
authors.lastname: Sabeti
authors.forename: Michael
authors.initials: M
authors.lastname: Tarnoff
authors.forename: Julie
authors.initials: J
authors.lastname: Kim
authors.forename: Scott
authors.initials: S
authors.lastname: Shikora
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D010537:Peritoneum / Q000601:surgery; D011028:Pneumoperitoneum, Artificial / Q000295:instrumentation*; D013525:Surgical Instruments