title: Bladeless direct optical trocar insertion in laparoscopic procedures on the obese patient.
abstract: BACKGROUND
  Recently, we have shown advantages of a direct optical entry (DOE) using a bladeless trocar in comparison with the open Hasson technique (OHT) in older reproductive-age women with previous operations, as well as in comparison with Veress needle entry in reproductive-age and postmenopausal women.
  
  
  OBJECTIVE
  A prospective multicenter randomized study to determine whether the DOE is feasible for establishing safe and rapid entry into the abdomen in comparison with those of the OHT in reproductive-age obese women.
  
  
  METHODS
  Two types of surgical techniques were blindly applied in 224 obese reproductive-age women with benign neoplastic diseases of ovary and uterus. Namely, laparoscopic entry into the abdomen in 108 patients was performed by DOE and in 116 women by OHT. Following parameters (entry time in seconds needed to establish the intra-abdominal vision after pneumoperitoneum, blood loss, occurrence of vascular and/or bowel injuries) were compared during surgery as main outcomes.
  
  
  RESULTS
  Main baseline characteristics of patients, including age (36.1 ± 4.5 vs 35.7 ± 5.8), body mass index (34.9 ± 5.1 vs 35.1 ± 4.9 kg/m(2)), and parity (2.1 ± 0.4 vs 1.9 ± 0.9), were not significantly different between the DOE and OHT groups (P > .05). While intraoperative parameters such as the entry time (71.9 ± 3.7 vs 215.1 ± 6.2 seconds) and blood loss value (9.7 ± 6.1 vs 12.2 ± 2.9 mL) were significantly reduced in the DOE group in comparison with those of OHT group (respectively, P < .0001 and < .01), there were also trends to slight decrease of the occurrence of the minor injuries, manifested as omental small vessels rupture (0 of 108 vs 4 of 116) and punctures and pinches of jejunal serosa (0 of 108 vs 3 of 116) in patients of the DOE group in comparison with those of OHT group (respectively, P = .0515 and = .0925).
  
  
  CONCLUSIONS
  DOE reduced entry time and blood loss with trends to slightly decrease of the occurrence of the minor vascular and bowel injuries, thus enabling a possible alternative to OHT in obese women; however, further larger trials need to confirm the possible additional benefits of a DOE.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Vito Fazzi Hospital, Piazza Muratore, 73100 Lecce, Italy. andreatinelli@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Tinelli
authors.affiliation: Department of Obstetrics and Gynaecology, Santa Maria Hospital, Bari, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Malvasi
authors.affiliation: Experimental Researches and Modeling Division, Moscow State University of Medicine and Dentistry, Moscow, Russia.
authors.forename: Ospan A
authors.initials: OA
authors.lastname: Mynbaev
authors.affiliation: Department of Gynecology, Division of Minimal Invasive Endoscopy, The Mount Sinai Hospital of Queens, New York, NY, USA.
authors.forename: Daniel Alberto
authors.initials: DA
authors.lastname: Tsin
authors.affiliation: Hospital Regional de Poza Rica, Sesver, Monterrey, Mexico.
authors.forename: Fausto
authors.initials: F
authors.lastname: Davila
authors.affiliation: Fundaciòn Hospitalaria, Buenos Aires, Argentina.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Dominguez
authors.affiliation: Department of Gynecology and Obstetrics, University of Perugia, Perugia, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Perrone
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, NY, USA, Division of Gynecologic Oncology and the Department of Obstetrics and Gynecology, St. Luke's-Roosevelt Hospital Center, New York, NY, USA.
authors.forename: Farr R
authors.initials: FR
authors.lastname: Nezhat
mesh_terms: D000328:Adult; D004867:Equipment Design; D005260:Female; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D009765:Obesity / Q000150:complications*; D010049:Ovarian Diseases / Q000150:complications* / Q000601:surgery*; D011446:Prospective Studies; D013525:Surgical Instruments; D014591:Uterine Diseases / Q000150:complications* / Q000601:surgery*