title: Laparoscopic entry techniques in obese patient: veress needle, direct trocar insertion or open entry technique?
abstract: Laparoscopy is a common procedure in bariatric surgery. Serious complications can occur during laparoscopic entry as reported by Ahmad et al. (Cochrane Database Syst Rev 15:2, 2012). Several techniques, instruments, and approaches to minimize the risk of injury (the bowel, bladder, major abdominal vessels, and an anterior abdominal wall vessel) have been introduced. These methods include the standard technique of insufflation after insertion of the Veress needle, the open (Hasson technique), the direct trocar insertion, and optical trocar insertion. Furthermore, it is more difficult to perform in the obese patient, especially if the first trocar is not umbilical. This is because obese patients have a very thick abdominal wall (particularly in women) as well as a thick peritoneum. The aim of this article was to demonstrate the safety of various laparoscopic entry techniques in obese patient.
authors.affiliation: Department of Bariatric Surgery, CHU Hospital, Jean Monnet University, Avenue Albert Raimond, 42270, Saint Etienne, France, Radwankassir42@hotmail.Fr.
authors.forename: Radwan
authors.initials: R
authors.lastname: Kassir
authors.forename: Pierre
authors.initials: P
authors.lastname: Blanc
authors.forename: Patrice
authors.initials: P
authors.lastname: Lointier
authors.forename: Olivier
authors.initials: O
authors.lastname: Tiffet
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Berger
authors.forename: Imed Ben
authors.initials: IB
authors.lastname: Amor
authors.forename: Jean
authors.initials: J
authors.lastname: Gugenheim
mesh_terms: D050110:Bariatric Surgery / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D009339:Needles; D009767:Obesity, Morbid / Q000601:surgery*; D013525:Surgical Instruments