Safety of Direct Trocar Insertion for Laparoscopic Procedures

Abstract

Creation of pneumoperitoneum is first step in laparoscopic surgeries. Four basic techniques are used to create pneumoperitoneum i.e. blind veress needle (VN), direct trocar insertion (DTI), optical trocar insertion (OTI) and open method. Objective: The objective of the study is to determine the safety of direct trocar insertion for laparoscopic procedures. Setting: Department of Surgery, Allied/DHQ Hospital and Mujahid hospital Faisalabad. Duration of study: From 01-01-2013 to 31-12-2017 over a period of five years. Study design: Prospective randomized study. Methodology: A total of 1500 cases undergoing laparoscopic procedures were included in study.1470 (98%) patients had pneumoperitoneum established by DTI at umbilicus,25 patients by DTI at palmer’s point and only 1 patient has pneumoperitoneum established by open method. Results: Out of 1500 cases, 1280 were females and 220 were males, male to female ratio was 1:5.8. The age of patients varied between 16-70 years mean age was calculated as 33.22+9.31 years. Pneumoperitoneum by DTI at umbilicus was achieved successfully in 1474(98.26%), while it was established by DTI at palmer’s point in 25 (1.6%) patients. In only 1(0.06%) patient pneumoperitoneum was created by open method.1(0.06%) patient developed visceral injury,1(0.06%) patient developed port site hernia and 10(0.66%) patients developed port site infection. Conclusion: DTI is a safe and reliable technique for establishing pneumoperitoneum and should be used routinely.