A multi-center study of a modified open trocar first-puncture approach in 17 350 patients for laparoscopic entry

Laparoscopic entry is of primary importance in laparoscopic surgery because of its potential association with serious complications such as visceral and vascular injuries. There are several approaches now available for laparoscopic entry. The present study reported a modified open trocar first-puncture approach (Yan's open technique) and validated its safety and practicability in a multi-center research.

The study was performed in seven gynecological endoscopy centers for 8 successive years from September 1998 to March 2006 involving 17 350 patients, who received the modified open trocar first-puncture approach developed by Dr. LIU Yan as the study group (MOT group). The "Yan's open technique" is the umbilical incision with a scalpel and then a 10-mm trocar entry into the abdominal cavity through direct trocar puncture or insertion of the cannula sheath via the opened umbilicus under no resistance. Another 4570 patients received the traditional Veress needle puncture as the control (VN group). The first puncture procedures of both groups were performed by 28 experienced gynecologic laparoscopists and 170 learners.

In MOT group, the successful achievement rate (AR) of first puncture was 99.99% (17 348/17 350), including smooth manipulation in 17 326 cases and unsmooth manipulation in 22 cases. The remaining two cases failed. First-puncture associated complications occurred in two cases (0.01%). In VN group, the successful AR of first puncture was 99.89% (4565/4570), including smooth manipulation in 4542 cases and unsmooth manipulation in 23 cases. The remaining five cases failed. First-puncture associated complications occurred in four cases (0.09%). There was no significant difference in the successful AR between the experienced gynecologic laparoscopists of the two groups (100% vs 100%, P > 0.05), but the difference was significant between the learners of the two groups (99.98% vs 99.81%, P < 0.05). The complication rate of VN group was significantly higher than that of MOT group (0.09% vs 0.01%, P < 0.05).

Compared with the traditional Veress needle puncture, the modified open trocar first-puncture is easier to follow, especially for learners. In addition, it can avoid possible Veress needle-associated injuries. Opening the umbilical hole for the sake of minimizing or zeroing puncture resistance is a safer and more practicable maneuver for laparoscopic entry.