Direct insertion of the laparoscopic trocar after an earlier laparotomy

Direct insertion of the laparoscopic trocar without the aid of a prior pneumoperitoneum has been described previously. Prior laparotomy has been cited as a contraindication to this technique. At our free-standing ambulatory surgical unit, 1,670 consecutive laparoscopies utilizing direct insertion of the trocar were performed during a four-year period. Four hundred sixteen women had had previous abdominal surgery. One bowel injury occurred in this group. A patient without prior surgery sustained an intraabdominal laceration requiring further surgery and hospitalization. Based on this experience, we do not find previous abdominal surgery to be a contraindication to the use of direct insertion of the laparoscopic trocar.