Direct Primary Trocar Insertion without Prior Pneumoperitoneum is a Safe, Feasible and Quick Laparoscopic Entry Technique


ABSTRACT: BACKGROUND :In laparoscopic surgery, the primary (first) trocar entry is of a great importance because of it’s association with serious complications such as visceral and vascular injuries. There are several techniques for laparoscopic entry, the commonly used ones are Veress Needle (closed) and Hasson’s ( open ) techniqes. Recently, the Direct Primary Trocar Insertion (DPTI ) without prior pneumoperitoneum was reported as safe alternative laparoscopic entry technique .OBJECTIVE:This study assesses the safety ,feasibility ,complications and time of DPTI without a prior pneumoperitoneum in laparoscopic surgery. PATIENTS METHODS: This is a prospective study included 219 patients ,196 females ( 89.5 %) and 23 males (10.5 %), prepared for different laparoscopic procedures using only DPTI .Open laparoscopic entry ( Hasson’s technique ) was reserved for patients with associated small umbilical hernias or previous mid-line lapararotomy.Veress Needle ( VN ) and other methods of laparoscopic entry were not used.This study was performed in AL-Karama Teaching Hospital/ College of Medicine / Wasit University,IRAQ from April 2011 till July 2013 .Recorded data were : age,sex, indications for laparoscopic surgery,time of DPTI , laparoscopic entry related complications, conversion to laparotomy , length of hospital stay and the mortality.RESULTS AND DISCUSSION:DPTI technique was feasible in 208 patients (95%) while open laparoscopy was reserved for the remaining 11(5 %) patients . Conversion to laparotomy was done for 12 patients (5.47 %) . This study has no major complications nor deaths . Immediate minor complications occurred in 7 patients (3.2%).Late minor complications occurred in 6 patients(2.7 %).Time of DPTI was 1.80 ± 0.64 SD minutes, P-value= 0.01 . The follow-up period ranged from 2- 27 months .CONCLUSION: DPTI entry is a safe alternative to the Veress Needle and other techniques of laparoscopic entry and creation of pneumoperitoneum. It has shorter laparoscopic entry time than the other laparoscopic entry techniques.