Evaluation of Direct Trocar Insertion Technique at Laparoscopic Surgery
Iraqi Postgraduate Medical Journal,
2014, Volume 13, Issue 1, Pages 7-11
Commonly we utilize veress needle in laparoscopic surgery as usual to start with introduction of pneumoperitoneum in the abdomen (classic pneumoperitoneum], but there are alternatives to it for better and fast work even in obese patients.
The purpose of this study is to compare direct trocar (DT) to Veress needle (VN) entry for tie creation of pneumoperitoneum during laparoscopy with regard to the duration of the procedure (trocar and Veress placement time), volume of gas used, ease of performance, and frequency of complications through a randomized clinical study in Al-Karama hospital and some other private Baghdad hospitals.
PATIENTS AND METHODS:
60 patients scheduled to undergo diagnostic and therapeutic laparoscopy (general surgery and gynecology cases), 45 cases divided into DT (group A = 25) and VN (group B = 20), the other 15 cases were obese patients BMI>30, subdivided into two subgroups (1, 2) submitted for the study, they were randomly allocated to either DT or VN entry for pneumoperitoneum. The laparoscopic procedures performed by the same surgeon.
The trocar and Veress placement time, volume of gas consumption, ease of performance and frequency of complications were analyzed. The mean trocar and Veress placement time was significantly shorter in group A and subgroup 1 than in group B and subgroup 2. The mean gas consumption was significantly less in group A (2-3Iiters) and subgroup 1 than in group B and subgroup 2 (4-6 liters). No major complications (bowel, vessels injury) in both groups were encountered. Minor complications (failure pneumoperitoneum) were significantly less in group A and subgroup 1 than in group B and subgroup 2.
DT entry is a safe alternative to the VN entry technique for the creation of pneumoperitoneum. This approach has further advantages with less cost and instrumentation along with rapid creation of pneumoperitoneum even in obese patients.
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