Abstract
Background
We set out to assess the difference in complication rates between primary umbilical insertion by a blind trocar and insertion with an optical surgical obturator.
Methods
In a retrospective survey, we investigated the rate of severe complications by primary umbilical trocar entry. Of 1546 patients undergoing gynecological laparoscopies at a tertiary-care university hospital, 1000 cases were operated by blind umbilical insertion with a conventional primary trocar whereas 546 used an optical primary trocar.
Results
The rate of major complications during insertion of the primary trocar in the blind insertion group was five of 1000 (0.5%), whereas therewere no major complications in the optical-guided insertion group (0.0%).
Conclusions
In comparison with the blind insertion of a sharp trocar, optical guidance provides a safe and functional primary insertion method that allows to detect adhesions to be detected at an early stage, thus preventing injuries to the bowel and abdominal vessels.
Similar content being viewed by others
References
Ballem R, Ruddomanski J (1993) Techniques of pneumoperitoneum. Surg Laparosc Endosc 3: 2–43
Bateman BG, Kolp L, Hoeger K (1996) Complications of laparoscopy— operative and diagnostic. Fertil Steril 66: 30–35
Bergquist D, Bergquist A (1987) Vascular injuries during gynecologic surgery. Acta Obstet Gynecol Scand 66: 19–23
Brill AI, Nezhat F, Nezhat CH, Nezhat C (1995) The incidence of adhesions after prior laparotomy: a laparoscopic appraisal. Obstet Gynecol 85: 269–272
Chandler J, Voyles C, Floore T, Bartholomew L (1997) Ligitious consequences of open and laparoscopic biliary surgical mishaps. J Gastrointest Surg 1: 138–145
Chang F, Lee C, Soong Y (1994) Use of palmer’s Point for insertion of the operative laparoscope in patients with severe pelvic adhesions: experience of seventeen cases. J Am Assoc Gynecol Laparosc 1: 7
Chapron C, Pierre F, Lacroix S, Querleu D, Lansac J, Dubuisson J (1997) Major vascular injuries during gynecologic laparoscopy. J Am Coll Surg 185: 461–465
Chi IC, Feldblum PJ, Balogh SA (1983) Previous abdominal surgery as a risk factor in interval laparoscopic sterilisation. Am J Obstet Gynecol 145: 841–846
Cogliandolo A, Manganaro T, Saitta F, Micali B (1998) Blind versus open approach to laparoscopic cholecystectomy: a randomized study. Surg Laparosc Endosc 8: 353–355
Copeland C, Wing R, Hulka J (1983) Direct trocar insertion at laparoscopy: an evaluation. Obstet Gynecol 62: 655–659
Cordick C, Lecuru F, Rizk E, Robin F, Boucaya V, Taurelle R (1999) Morbidity in laparoscopic gynecological surgery. Results of a prospective single-center study. Surg Endosc 13: 57–61
Eypasch E, Lefering R, Kum CK, Troidl H (1995) Probability of adverse events that have not yet occurred: a statistical reminder. Br Med J 311: 619–620
Garry R (1997) Complications of laparoscopic entry. Gynecol Endosc 6: 319–329
Hallfeldt KKJ, Trupka A, Kalteis T, Stuetzle H (1999) Safe creation of pneumoperitoneum using an optical trocar. Surg Endosc 13: 306–307
Hasson H (1984) Open laparoscopy. In: Sciarra JJ, (ed). Gynecology and obstetrics; vol 6. Harper & Row, New York
Hill DJ (1994) Complications of the laparoscopic approach. Baillieres Clin Obstet Gynecol 8: 865–879
Hurd W, Randolph J, Holmberg R (1994) Open laparoscopy without special instruments or sutures comparison with a closed technique. J Reprod Med 39: 393–397
Jarrett J (1990) Laparoscopy: direct trocar insertion without pneumoperitoneum. Obstet Gynecol 75: 725–727
Kaali S, Barad D, Merkatz I (1997) Modified open laparoscopy through placement of an optical surgical obturator. Fertil Steril 67:969–971
Kaali SG, Bartfai G (1988) Direct insertion of the laparoscopic trocar after an earlier laparotomy. J Reprod Med 33: 739–740
Kern K (1997) Malpractice litigation involving laparoscopic cholecystectomy. Arch Surg 132: 392–398
Levely BS, Hulka JF, Peterson HB (1994) Operative laparoscopy: American Association of Gynecologic Laparoscopists. members’ survey. J Am Assoc Gynecol Laparosc 1: 301–306
Levy B, Sonderstrom R, Dail D (1985). Bowel injuries during laparoscopy: gross anatomy and histology. J Reprod Med 30: 168–172
Leonard F, Lecuru F, Rizk E, Chasset S, Robin F, Taurelle R (2000) Perioperative morbidity of gynecological laparoscopy: a prospective monocenter observational study. Acta Obstet Gynecol Scand 79: 129–134
Loffer F, Pent D (1975) Indications, contraindications and complications of laparoscopy. Obstet Gynecol Surv 30: 407–423
McCarus S (1995) Visual application of the Visiport trocar system for safe direct-vision laparoscopy. J Am Assoc Gynecol Laparosc 2: 74
Mintz M (1977) Risks an prophylaxis in laparoscopy: a survey of 100,000 cases. J Reprod Med 18: 269–272
Nezhat C, Nezhat F, Luciano A (1995) Operative gynecologic laparoscopy: principles and techniques. McGraw-Hill, New York, pp 79–96
Nuzzo G, Giuliante F, Tebala G (1997) Routine use of open technique in laparoscopic operations. J Am Coll Surg 184: 58–62
Penfield AJ (1985) How to prevent complications of open laparoscopy. J Reprod Med 30: 660–663
Richardson R, Sutton C (1998) Laparoscopy in a day surgery unit: a prospective complication audit. Presented at the 7th Congress of the European Society for Gynecological Endoscopy, Lausanne, Switzerland 8–11 December 1998
Rosen D, Lam A, Chapman M, Charlton M, Cario G (1998) Methods of creating pneumoperitoneum: a review of techniques and complications. Obstet Gynecol Surv 53: 167–173
Sageghi-Nejad H, Kavuossi L, Peters C (1994) Bowel injury in open technique laparoscopic cannula placement. Urology 43: 559–560
Semm K (1988) Sichtkontrollierte Peritoneumperforation zur operativen Pelviskopie. Geburtsh u Frauenheilk 48: 436–439
Sigman H, Fried G, Garzon J (1993) Risks of blind versus open approach to celiotomy for laparoscopic surgery. Surg Laparosc Endosc 3: 296–299
String A, Berber E, Foroutani A, Macho JR, Pearl JM, Siperstein AE (2001) Use of the optical access trocar for safe and rapid entry in various laparoscopic procedures. Surg Endosc 15: 570–573
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Jirecek, S., Dräger, M., Leitich, H. et al. Direct visual or blind insertion of the primary trocar. Surg Endosc 16, 626–629 (2002). https://doi.org/10.1007/s00464-001-9089-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-001-9089-3