title: Direct trocar insertion technique for initial access in morbid obesity surgery: technique and results.
abstract: OBJECTIVE
  Obtaining access to the peritoneal cavity in laparoscopic surgery is more difficult in morbidly obese patients. There is no clear consensus as to the optimal method of entry into the peritoneal cavity. This study assesses the safety and feasibility of the direct trocar insertion technique without pre-existing pneumoperitoneum in patients undergoing laparoscopic bariatric surgery.
  
  
  METHODS
  From February 2006 to July 2009, 155 morbidly obese patients underwent laparoscopic adjustable gastric band surgery. There were 128 women (82.6%) and 27 men (17.4%). The mean age was 41 and ranged between 18 and 59 years.
  
  
  RESULTS
  All patients met the National Institutes of Health criteria for bariatric surgery. The mean body mass index was 45 kg/m (range 35 to 61). There was no evidence of intestinal or vascular injury during trocar placement. Immediate minor complications were extraperitoneal insufflations in 5 patients, gastric serosal laceration in 1 patient, and left liver lobe laceration in 1 patient. No major complications were associated with this technique.
  
  
  CONCLUSIONS
  All complications related to the direct trocar insertion technique were minor and these complications did not affect the success of surgery. We concluded that the direct trocar technique for initial access in laparoscopic bariatric surgery provides safe and quick entry into the peritoneal cavity.
authors: Department of General Surgery, Fatih Sultan Mehmet EA Hospital, Istanbul, Turkey. haltun@hotmail.com.tr
authors: Hasan
authors: H
authors: Altun
authors: Oktay
authors: O
authors: Banli
authors: Rojbin
authors: R
authors: Karakoyun
authors: Abdullah
authors: A
authors: Boyuk
authors: Mehmet
authors: M
authors: Okuducu
authors: Ender
authors: E
authors: Onur
authors: Kemal
authors: K
authors: Memisoglu
mesh_terms: D000293:Adolescent; D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult