Laparoscopic peritoneal entry with the reusable threaded visual cannula.
OBJECTIVE
To estimate the feasibility, reproducibility, and safety of laparoscopic port establishment using a trocarless and externally threaded visual cannula (TVC).


METHODS
Multicentre, prospective, observational study (Canadian Task Force classification II-2).


METHODS
Three university-affiliated teaching hospitals.


METHODS
Four thousand seven hundred twenty-four women (median age, 34 years; median body mass index, 25) underwent laparoscopic surgery.


METHODS
After administration of general anesthesia, the Veress needle was inserted at the umbilicus or the left upper quadrant (LUQ) using Veress intraperitoneal pressure of 10 mm Hg or less as proxy for correct placement. Transient high intraperitoneal pressure of 20 to 30 mm Hg was attained, and primary and ancillary ports were established using the reusable trocarless TVC.


RESULTS
Institutional research ethics board approval and patient consent for video capture were obtained. Primary umbilical entry was established in 4598 patients (97.33%), primary LUQ entry in 123 (2.60%), and primary suprapubic entry in 3 (0.06%) patients. Peritoneal preinsufflation was abandoned when 3 consecutive umbilical or LUQ Veress needle insertion attempts failed. Some patients at high risk with known peritoneal adhesions or previous lower abdominal midline scars did not undergo preinsufflation, and the trocarless TVC was applied directly. Surgery was postponed in 3 patients in whom insufflation failed, to enable further counseling and appropriate consenting. There were no serious abdominal wall or intraabdominal vascular injuries. One transverse colon, densely adhered to the umbilical region, was injured, which was recognized and repaired intraoperatively. Residents, fellows, or faculty recorded entry-related data on forms postoperatively for study and analysis.


CONCLUSIONS
Establishing peritoneal ports with the trocarless TVC is feasible, reproducible, and seems to be highly adoptable.
Ternamian
Artin M
AM
Department of Obstetrics and Gynecology, Division of Gynecologic Endoscopy, St. Joseph's Health Centre, University of Toronto, Toronto Ontario, Canada. artin.ternamian@utoronto.ca
Vilos
George A
GA
Vilos
Angelos G
AG
Abu-Rafea
Basim
B
Tyrwhitt
Jessica
J
MacLeod
Natalie T
NT
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007327:Insufflation; D020706:Laparoscopes; D010535:Laparoscopy; D008875:Middle Aged; D010529:Peritoneal Cavity / Q000601:surgery*; D011446:Prospective Studies; D055815:Young Adult