A technique for needle insufflation in obese patients

Creation of pneumoperitoneum as the first step in closed laparoscopy and the insertion of a primary trocar are the only "blind" steps in laparoscopy. These steps have occasionally been associated with technical difficulties and complications and with prolonged operative time. These problems are compounded in obese patients. In this report, we describe a simple and safe technique for needle insufflation and insertion of a primary trocar. With this technique, instead of lifting and elevating the anterior abdominal wall by grasping the skin and panniculus adiposus with hands or tennaculae, the abdominal fascia is grasped with two Kocher clamps and then lifted and held immobile during needle and trocar insertion. This maneuver provides much better visual and tactile control and is done more expeditiously, particularly in obese patients.