title: Safety of open technique for first-trocar placement in laparoscopic surgery: a series of 6,000 cases.
abstract: BACKGROUND
  The open technique for the placement of the first trocar in laparoscopic surgery has become the preferred method due to the reduced number of complications associated with it. In 2002 we reported our technique, which has been widely accepted at many centers, including all the units of our hospital. We now report on a series of 6,000 cases in which this technique was used.
  
  
  METHODS
  The method is the same as that reported by us previously (Surg Endosc 16:1366-1370, [10]) except for the minor modification of using a Mayo towel clip instead of the Allis forceps for holding the cicatrix pillar, as the pillar tends not to slip out of the former. During closure, Allis forceps is used to lift the divided rectus sheath on each side to take the suture bite and ensure complete secure closure. A total of 6,000 consecutive cases have been performed using this technique in two tertiary care hospitals over the last 11 years.
  
  
  RESULTS
  A total of 6,000 cases (5,350 females and 650 males) were operated on over an 11-year period. There were no visceral or vascular complications. Four hundred seventy-five patients (7.9%) had had previous abdominal surgery. The supraumbilical route was used in 348 patients and lateral entry in 90 patients. Port-site hernias were seen in 25 cases (0.4%) and wound infections in 56 cases (0.9%). The average time for trocar placement was 2 min (range = 1-12 min) and the average port size was 15 mm (range = 12-22 mm). The average time for port closure at the end of the procedure was 3 min (range = 1-7 min).
  
  
  CONCLUSIONS
  The technique of open-trocar placement in laparoscopic surgery has now become standardized, with its safety having been well established. Our experience has shown that this technique is safe, effective, reproducible, easy to learn, can be performed quickly, and has excellent results.
authors.affiliation: Department of Surgery, Maulana Azad Medical College, New Delhi, 110002, India. profplal@gmail.com
authors.forename: Pawanindra
authors.initials: P
authors.lastname: Lal
authors.forename: Anubhav
authors.initials: A
authors.lastname: Vindal
authors.forename: Rajeev
authors.initials: R
authors.lastname: Sharma
authors.forename: Jagdish
authors.initials: J
authors.lastname: Chander
authors.forename: Vinod Kumar
authors.initials: VK
authors.lastname: Ramteke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002921:Cicatrix / Q000209:etiology; D004210:Dissection / Q000295:instrumentation; D005260:Female; D046449:Hernia, Abdominal / Q000601:surgery; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D013525:Surgical Instruments; D013530:Surgical Wound Infection / Q000209:etiology; D055815:Young Adult