Direct Trocar Insertion for the Establishment of Pneumoperitoneum in Laparoscopic Procedures.A review of the Literature

Abstract

Background: the creation of pneumoperitoneum is a sine qua non for the performance of laparoscopic procedures. There are several methods of establishing pneumoperitoneum and they include Veress needle insertion, open (Hasson) technique, optical trocars,self expanding shielded trocars and direct trocar insertion.The aim of this review is to highlight direct trocar insertion as a technique of initial entry and insuffation and also compare it to other well knocwn techniques in terms of technical difficulty,success rate,
time forinsertion and complication rate.

Methods: A literature search was conducted with the Google searchengine. The Pubmed and Google scholar databases were searched. Studies were classified into 4 categories,those that addressed insuflation and entry techniques in general (A),those that dealt with complications of various entry teclniques (B), those that showed the authors' experiences with direct trocar insertion (C) and those comparing direct trocar insertion with other entry techniques (D).Data on the success rate, complication rate and time taken to achieve
insuffation were taken and analysed.

Results: A total of 26 relevant articles were reviewed. Eight articles were in category A, four each in categories B and C and 12 in category D. The success rates ranged from 99.5%to 100%. There was also a significant difference in favour of direct trocar insertion in the time taken to achieve pneumoperitoneum. 

Conclusions: Direct trocar insertion is easy to perform, safe, has high success rate and low complication rate. It is a worthy alternative for other well established techniques.