Direct Vision Entry with Integrated Insufflation

The Veress and Hasson methods for establishing a pneumoperitoneum for laparoscopic surgery have recognized limitations and risks. The use of a direct vision entry port with insufflation, however, is less widely described. This study aimed to assess the success, safety, and efficiency of this technique.

The Kii Fios First Entry system was used in 100 consecutive cases of renal surgery. The camera is placed within the trocar and advanced under direct vision through the abdominal wall layers with simultaneous insufflation. Patient body mass index (BMI), time to pneumoperitoneum, and complications were recorded.

The cohort consisted of 59% females, a mean BMI of 31.2 kg/m², and 19% with a history of previous abdominal surgery. The primary indications were pelvic ureteric junction obstruction (49%) and nonfunctioning kidney (26%). The mean time to pneumoperitoneum was 29.4 seconds (range 5-180 seconds). First-attempt success occurred in 90 cases, with 10 cases requiring more than one attempt. Entries were performed by consultants (65%) and by trainees (35%). When stratified by operator grade, there was no significant difference in entry time between consultants and trainees (median 25 vs 26 seconds; Mann-Whitney P = .35) or in first-attempt success rates. Prior abdominal surgery did not affect the success rate of the first attempt. BMI group (<30 vs ≥30) and American Society of Anesthesiologists (ASA) grade were also not associated with success.

The Kii Fios First Entry system represents a safe, easy, and inexpensive alternative for establishing pneumoperitoneum in laparoscopic surgery, with very short entry times in this series.