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Initial Access to the Peritoneal Cavity for Laparoscopic Surgery in Obese Patients

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Laparoscopic Entry

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Abstract

With the increasing incidence of obesity [1–3], a growing number of obese patients (body mass index, BMI, greater than 30 kg/m2) are treated for common intra-abdominal diseases and also undergo weight loss or bariatric surgery [4, 5]. The use of laparoscopic techniques for general and bariatric surgery is preferred because it is associated with less postoperative pain, lower rates of wound infection and incisional hernias, faster recovery, shorter hospital stay, and earlier return to work [1, 6–10]. Obtaining safe access to the peritoneal cavity to create a pneumoperitoneum is a crucial step to start a laparoscopic operation, and it is, however, technically challenging and associated with more complications in obese and morbidly obese people [11]. To date, there is no clear consensus about the optimal method of entry into the peritoneal cavity, and therefore different techniques are available.

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References

  1. Eisenberg D, Duffy AJ, Bell RL. Update on obesity surgery. World J Gastroenterol. 2006;12:3196–203.

    PubMed  Google Scholar 

  2. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2008. Obes Surg. 2009;19:1605–11.

    Article  PubMed  Google Scholar 

  3. Fried M, Hainer V, Basdevant A, et al. Interdisciplinary European guidelines for surgery for severe (morbid) obesity. Obes Surg. 2007;17:260–70.

    Article  PubMed  Google Scholar 

  4. Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005;294:1909–17.

    Article  PubMed  CAS  Google Scholar 

  5. Steinbrook R. Surgery for severe obesity. N Engl J Med. 2004;350:1075–9.

    Article  PubMed  CAS  Google Scholar 

  6. Cottam DR, Nguyen NT, Eid GM, Schauer PR. The impact of laparoscopy on bariatric surgery. Surg Endosc. 2005;19:621–7.

    Article  PubMed  CAS  Google Scholar 

  7. Campos GM, Ciovica R, Rogers SJ, et al. Spectrum and risk factors of complications after gastric bypass. Arch Surg. 2007;142:969–75; discussion 976.

    Article  PubMed  Google Scholar 

  8. Sekhar N, Torquati A, Youssef Y, et al. A comparison of 399 open and 568 laparoscopic gastric bypasses performed during a 4-year period. Surg Endosc. 2007;21:665–8.

    Article  PubMed  CAS  Google Scholar 

  9. Nguyen NT, Hinojosa M, Fayad C, et al. Use and outcomes of laparoscopic versus open gastric bypass at academic medical centers. J Am Coll Surg. 2007;205:248–55.

    Article  PubMed  Google Scholar 

  10. Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234:279–89; discussion 289–91.

    Article  PubMed  CAS  Google Scholar 

  11. Madan AK, Menachery S. Safety and efficacy of initial trocar placement in morbidly obese patients. Arch Surg. 2006;141:300–3.

    Article  PubMed  Google Scholar 

  12. Radojcic B, Jokic R, Grebeldinger S, Meljnikov I, Radojic N. et al. History of minimally invasive surgery. Med Pregl. 2009;62:597–602.

    PubMed  Google Scholar 

  13. Bridgewater FH, Mouton WG. Rationale and intended use for the Veress needle: a translation of the original descriptive article. Surg Laparosc Endosc Percutan Tech. 1999;9:241–3.

    Article  PubMed  CAS  Google Scholar 

  14. Schwartz ML, Drew RL, Andersen JN. Induction of pneumoperitoneum in morbidly obese patients. Obes Surg. 2003;13:601–4; discussion 604.

    Article  PubMed  Google Scholar 

  15. Vilos GA, Ternamian A, Dempster J, et al. Laparoscopic entry: a review of techniques, technologies, and complications. J Obstet Gynaecol Can. 2007;29:433–65.

    PubMed  Google Scholar 

  16. Hurd WH, Bude RO, DeLancey JO, et al. Abdominal wall characterization with magnetic resonance imaging and computed tomography. The effect of obesity on the laparoscopic approach. J Reprod Med. 1991;36:473–6.

    PubMed  CAS  Google Scholar 

  17. Hurd WW, Bude RO, DeLancey JO, Pearl ML. The relationship of the umbilicus to the aortic bifurcation: implications for laparoscopic technique. Obstet Gynecol. 1992;80:48–51.

    PubMed  CAS  Google Scholar 

  18. Philips PA, Amaral JF. Abdominal access complications in laparoscopic surgery. J Am Coll Surg. 2001;192:525–36.

    Article  PubMed  CAS  Google Scholar 

  19. Teoh B, Sen R, Abbott J. An evaluation of four tests used to ascertain Veres needle placement at closed laparoscopy. J Minim Invasive Gynecol. 2005;12:153–8.

    Article  PubMed  Google Scholar 

  20. Champault G, Cazacu F, Taffinder N. Serious trocar accidents in laparoscopic surgery: a French survey of 103,852 operations. Surg Laparosc Endosc. 1996;6:367–70.

    Article  PubMed  CAS  Google Scholar 

  21. Dunne N, Booth MI, Dehn T. Establishing pneumoperitoneum: Verres or Hasson? The debate continues. Ann R Coll Surg Engl. 2011;93:22–4.

    Article  PubMed  CAS  Google Scholar 

  22. Merlin TL, Hiller JE, Maddern GJ, et al. Systematic review of the safety and effectiveness of methods used to establish pneumoperitoneum in laparoscopic surgery. Br J Surg. 2003;90:668–79.

    Article  PubMed  CAS  Google Scholar 

  23. Catarci M, Carlini M, Gentileschi P, Santoro E. Major and minor injuries during the creation of pneumoperitoneum. A multicenter study on 12,919 cases. Surg Endosc. 2001;15:566–9.

    Article  PubMed  CAS  Google Scholar 

  24. Bonjer HJ, Hazebroek EJ, Kazemier G, et al. Open versus closed establishment of pneumoperitoneum in laparoscopic surgery. Br J Surg. 1997;84:599–602.

    Article  PubMed  CAS  Google Scholar 

  25. Azevedo JL, Azevedo OC, Miyahira SA, et al. Injuries caused by Veress needle insertion for creation of pneumoperitoneum: a systematic literature review. Surg Endosc. 2009;23:1428–32.

    Article  PubMed  Google Scholar 

  26. van Goor H. Consequences and complications of peritoneal adhesions. Colorectal Dis. 2007;9 Suppl 2:25–34.

    Article  PubMed  Google Scholar 

  27. Hasson HM. A modified instrument and method for laparoscopy. Am J Obstet Gynecol. 1971;110:886–7.

    PubMed  CAS  Google Scholar 

  28. Rosenthal RJ, Szomstein S, Kennedy CI, Zundel N. Direct visual insertion of primary trocar and avoidance of fascial closure with laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2007;21:124–8.

    Article  PubMed  CAS  Google Scholar 

  29. Altun H, Banli O, Karakoyun R, et al. Direct trocar insertion technique for initial access in morbid obesity surgery: technique and results. Surg Laparosc Endosc Percutan Tech. 2010;20:228–30.

    Article  PubMed  Google Scholar 

  30. Yerdel MA, Karayalcin K, Koyuncu A, et al. Direct trocar insertion versus Veres needle insertion in laparoscopic cholecystectomy. Am J Surg. 1999;177:247–9.

    Article  PubMed  CAS  Google Scholar 

  31. Byron JW, Markenson G, Miyazawa K. A randomized comparison of Verres needle and direct trocar insertion for laparoscopy. Surg Gynecol Obstet. 1993;177:259–62.

    PubMed  CAS  Google Scholar 

  32. Nezhat FR, Silfen SL, Evans D, Nezhat C. Comparison of direct insertion of disposable and standard reusable laparoscopic trocars and previous pneumoperitoneum with Veres needle. Obstet Gynecol. 1991;78:148–50.

    PubMed  CAS  Google Scholar 

  33. Borgatta L, Gruss L, Barad D, Kaali SG. Direct trocar insertion vs. Verres needle use for laparoscopic sterilization. J Reprod Med. 1990;35:891–4.

    PubMed  CAS  Google Scholar 

  34. Olvera D, Gomez JR. Pneumoperitoneum: its alternatives. Surg Laparosc Endosc. 1997;7:332–4.

    Article  PubMed  CAS  Google Scholar 

  35. Jarrett 2nd JC. Laparoscopy: direct trocar insertion without pneumoperitoneum. Obstet Gynecol. 1990;75:725–7.

    PubMed  Google Scholar 

  36. Altun H, Banli O, Kavlakoglu B, et al. Comparison between direct trocar and Veress needle insertion in laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A. 2007;17:709–12.

    Article  PubMed  Google Scholar 

  37. Rabl C, Palazzo F, Aoki H, Campos GM. Initial laparoscopic access using an optical trocar without pneumoperitoneum is safe and effective in the morbidly obese. Surg Innov. 2008;15:126–31.

    Article  PubMed  Google Scholar 

  38. Berch BR, Torquati A, Lutfi RE, Richards WO. Experience with the optical access trocar for safe and rapid entry in the performance of laparoscopic gastric bypass. Surg Endosc. 2006;20:1238–41.

    Article  PubMed  Google Scholar 

  39. Bernante P, Foletto M, Toniato A. Creation of pneumoperitoneum using a bladed optical trocar in morbidly obese patients: technique and results. Obes Surg. 2008;18:1043–6.

    Article  PubMed  Google Scholar 

  40. Sabeti N, Tarnoff M, Kim J, Shikora S. Primary midline peritoneal access with optical trocar is safe and effective in morbidly obese patients. Surg Obes Relat Dis. 2009;5:610–4.

    Article  PubMed  Google Scholar 

  41. Swank DJ, Bonjer HJ, Jeekel J. Safe laparoscopic adhesiolysis with optical access trocar and ultrasonic dissection. A prospective study. Surg Endosc. 2002;16:1796–801.

    Article  PubMed  CAS  Google Scholar 

  42. Jirecek S, Drager M, Leitich H, et al. Direct visual or blind insertion of the primary trocar. Surg Endosc. 2002;16:626–9.

    Article  PubMed  CAS  Google Scholar 

  43. Hallfeldt KK, Trupka A, Kalteis T, Stuetzle H. Safe creation of pneumoperitoneum using an optical trocar. Surg Endosc. 1999;13:306–7.

    Article  PubMed  CAS  Google Scholar 

  44. Angelini L, Lirici MM, Papaspyropoulos V, Sossi FL. Combination of subcutaneous abdominal wall retraction and optical trocar to minimize pneumoperitoneum-related effects and needle and trocar injuries in laparoscopic surgery. Surg Endosc. 1997;11:1006–9.

    Article  PubMed  CAS  Google Scholar 

  45. Sharp HT, Dodson MK, Draper ML, et al. Complications associated with optical-access laparoscopic trocars. Obstet Gynecol. 2002;99:553–5.

    Article  PubMed  Google Scholar 

  46. String A, Berber E, Foroutani A, et al. Use of the optical access trocar for safe and rapid entry in various laparoscopic procedures. Surg Endosc. 2001;15:570–3.

    Article  PubMed  CAS  Google Scholar 

  47. Liu CD, McFadden DW. Laparoscopic port sites do not require fascial closure when nonbladed trocars are used. Am Surg. 2000;66:853–4.

    PubMed  CAS  Google Scholar 

  48. Shalhav AL, Barret E, Lifshitz DA, et al. Transperitoneal laparoscopic renal surgery using blunt 12-mm trocar without fascial closure. J Endourol. 2002;16:43–6.

    Article  PubMed  Google Scholar 

  49. Hamade AM, Issa ME, Haylett KR, Ammori BJ. Fixity of ports to the abdominal wall during laparoscopic surgery: a randomized comparison of cutting versus blunt trocars. Surg Endosc. 2007;21:965–9.

    Article  PubMed  CAS  Google Scholar 

  50. Dingfelder JR. Direct laparoscope trocar insertion without prior pneumoperitoneum. J Reprod Med 1978, 21(1):45–47.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Paracelsus Private Medical University, Salzburg, Austria

    Charlotte Rabl

  2. University of Wisconsin School of Medicine and Public Health, Madison, WI, 53792-7375, USA

    Guilherme M. Campos

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  1. Charlotte Rabl
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  2. Guilherme M. Campos
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Editors and Affiliations

  1. , Gynecology and Obstetric, Vito Fazzi Hospital, Lecce, 73100, Italy

    Andrea Tinelli

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Rabl, C., Campos, G.M. (2012). Initial Access to the Peritoneal Cavity for Laparoscopic Surgery in Obese Patients. In: Tinelli, A. (eds) Laparoscopic Entry. Springer, London. https://doi.org/10.1007/978-0-85729-980-2_4

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  • DOI: https://doi.org/10.1007/978-0-85729-980-2_4

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  • Publisher Name: Springer, London

  • Print ISBN: 978-0-85729-979-6

  • Online ISBN: 978-0-85729-980-2

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