New technique for optical control of the first trocar insertion

In laparoscopic surgery serious complications caused by the blind insertion of the first trocar have been reported even after the pneumoperitoneum is established by means of a Veress needle. As a consequence, some techniques to safely insert the first port have been developed. Many surgeons advocate a minilaparotomy to position the first port. However, especially in obese patients, the dissection to insert the Hasson's trocar may be difficult and time consuming. As an alternative, optical disposable trocars have been studied and produced to be safely positioned under direct visualization.

A new technique to insert, under adequate optical control, a non disposable standard port is described. Personal experience in 126 consecutive patients is reviewed. Data were recorded prospectically and insertion time was recorded in every case.

Medium time of trocar insertion was 55 sec (range 30-160 sec). Identification of distinct layers of the abdominal wall was always possible. There were no complications related to the insertion of the first reusable cannula under visual control.

This technique may be considered a safe, simple and cost effective method to insert the first trocar.