Comparison of Direct Trocar Insertion with Other Techniques for Laparoscopy.

Objective: To assess the safety of direct trocar insertion (DTI) before creating pneumoperitoneum in laparoscopic procedures.

Study Design: An observational study.

Place And Duration Of Study: Combined Military Hospital (CMH) Kohat, Pakistan from November 2013 to January 2015.

Methodology: All the cases undergoing laparoscopy at the study centre in the above duration were included in the study after approval from the Hospital Ethical Committee and informed written consent. Out of the 200 cases, DTI was successfully used to establish peritoneal access in 190 cases, while open Hassen's technique (OL) was used in ten cases. Body mass index (BMI) of all the patients was calculated before surgery. All the cases were performed under general anaesthesia with adequate relaxation. A 10 mm permanent re-useable sharp metallic trocar was inserted through umbilical scar after lifting the abdominal wall using towel clamps. Studied variables included age, gender, BMI, operations, history of previous surgery, number of attempts for DTI and complications.

Results: Mean age of the patients in DTI group was 46.58 ±13.94 years, while 48.70 ±10.08 years in OL group. Female to male ratio in DTI group was 1.43:1; and 2.33:1 in OL group. Increase in BMI had a relation with number of unsuccessful attempts of DTI, so obesity was the main reason of failure of DTI.

Conclusion: DTI is a safe and effective method of peritoneal access for laparoscopy with very low failure rate related to BMI and minimal complications.