Creation of pneumoperitoneum using a bladed optical trocar in morbidly obese patients: technique and results

It is advised by the manufacturer that the bladed optical trocar is to be applied only after CO(2) insufflation. However, after a long experience with bladed optical trocars after CO(2) insufflation in bariatric patients, we found that it is possible to enter the abdomen with this trocar prior to insufflation. This investigation was performed to test the hypothesis that this bladed technique under direct visualization before abdominal insufflation is a safe and effective method for initial trocar placement for laparoscopic bariatric procedures.

Data on a series of 200 consecutive laparoscopic bariatric procedures with bladed optical access trocar were reviewed. The entry time for the optical trocar was measured in 70 patients. All the operative reports were reviewed for the following data: (1) successful initial trocar placement, (2) vascular injury during initial trocar placement, and (3) hollow viscus injury accessing the peritoneal cavity with bladed trocar. The trocar placement time was defined as the time to place the trocar into the peritoneal cavity after skin incision and was recorded in the last 70 cases.

There was no evidence of any vascular injury during initial trocar placement. There was no evidence of hollow viscus or organ injury during initial trocar placement. The insertion of the initial trocar was successful in all the patients. The average trocar insertion time was 20 s (range 10-50), and BMI did not affect the time of insertion.

We think that our technique of entering the abdominal cavity via a bladed optical trocar without prior abdominal insufflation can be performed safely in morbidly obese patients. More studies and larger series are needed to validate this method.