Bladeless Direct Optical Trocar Insertion in Laparoscopic Procedures on the Obese Patient

Tinelli, Andrea; Malvasi, Antonio; Mynbaev, Ospan A.; Tsin, Daniel A.; Dávila, Fausto; Domı́nguez, Gema; Perrone, Emanuele; Nezhat, Farr

doi:10.4293/108680813x13693422519398

Cited by 41 publications

(24 citation statements)

References 19 publications

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“…Several devices that use a 5‐ or 10‐mm endoscope have been developed: Visiport bladeless or bladed and Versaport bladeless trocars (Medtronic, Minneapolis, Minnesota), Xcel endopath bladeless (Ethicon, Somerville, New Jersey), and Ternamian EndoTIP cannula (Karl Storz, Goleta, California). The EndoTIP does not have a trocar . The other optical entry devices have a trocar that is transparent, with either a round or sharp tip.…”

Section: Entry Techniquesmentioning

confidence: 99%

Laparoscopic entry techniques: What is the controversy?

Monnet

2019

Veterinary Surgery

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Objective: To review reported complications related to the different laparoscopic entry techniques in the human and veterinary literature and describe the benefits and limitations of each technique. Study design: Literature review of 57 peer-reviewed articles. Methods: An electronic database search identified human and veterinary literature describing complications related to entry technique during laparoscopy. Results: Open-and closed-entry techniques may result in trauma of abdominal organs or vasculature. During laparoscopy in man, injury to bowel and major vasculature is reported in 0.02% and 0.04% of procedures with open-or closed-entry techniques, respectively. Designs of Veress needles and trocar cannula assemblies have been developed to improve ease and safety. Early complications, defined as those observed at the time of port entry into the abdominal cavity, result from the puncture of a blood vessel leading to substantial visible hemorrhage. Late complications are detected 24 or 48 hours after surgery and result from the puncture of a loop of intestine that was not detected at the time of initial surgery. The major reasons for iatrogenic trauma in man are related to anatomical factors and the presence of adhesions. No explanation for cause of complications was identified for animals. Conclusion: There is no consensus in the human or veterinary literature about the best entry technique for laparoscopy. The rate of complications related to entry technique in small animals is not known because the data are underreported. Clinical significance: Complications related to entry techniques are expected in both man and animals. Improvements in techniques and equipment design are being developed to minimize risk.

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Section: Entry Techniquesmentioning

confidence: 99%

Laparoscopic entry techniques: What is the controversy?

Monnet

2019

Veterinary Surgery

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“…[6] The pneumoperitoneum stage is one of the most important stages in laparoscopy, and most of the complications are related to this procedure. [2] Intra-abdominal entries using Veress needle or directly with trocar are the most frequently used intra-abdominal laparoscopic access routes. [4] Although studies report that the intra-abdominal entry using a Veress needle is safer than the direct trocar insertion, this issue is still controversial.…”

Section: Discussionmentioning

confidence: 99%

“…[1] Complications mostly occur during creation of pneumoperitoneum. [2] These can be life-threatening complications such as subcutaneous emphysema, bowel and bladder trauma, infection, and major abdominal blood vessels injury. Injuries due to trocar entry constitute 40% of all laparoscopic surgical complications.…”

Section: Introductionmentioning

confidence: 99%

A Randomized Controlled Trial Comparing Laparoscopic Access with the DTI and VNI

Ertuğrul¹

2019

South Clin Ist Euras

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Establishing a safe pneumoperitoneum in laparoscopic surgery is the beginning of the surgery. This study aimed to compare Veress needle insertion (VNI) and direct trocar insertion (DTI) methods. Methods: A total of 122 patients who underwent laparoscopic intervention mainly laparoscopic cholecystectomy, between August 2017 and February 2018, in the general surgery clinic were randomized. Among all patients, 62 were insufflated and operated using VNI and 60 with DTI method. The number of laparoscopic entrances, time of entry, complications, and postoperative pain were compared between the groups. Results: The two groups were similar in terms of demographic characteristics. A statistically significant difference was observed between the DTI and VNI groups regarding the entry time, pneumoperitoneum formation time, and gas leakage variables. A statistically significant difference was also observed between the DTI and VNI groups in the number of insertions. For the other variables, no statistically significant difference was observed between the DTI and VNI groups. Conclusion: In DTI, the duration of the generation of the pneumoperitoneum was significantly shorter. However, gas leakage was higher in the DTI group. No significant difference was observed in other variables. The DTI may be preferable to VNI according to time.

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“…The distance between both points was measured and, if the distance was greater than 25 cm, then additional ports for camera and instrument were placed closer to the xiphoid process. 17 Tinelli et al 18 specifically looked at initial trocar placement in morbidly obese females. The surgeons entered with an optical trocar through the umbilicus and found a slightly reduced risk of bleeding and bowel injury.…”

Section: Discussionmentioning

confidence: 99%

Optimal Initial Trocar Placement for Morbidly Obese Patients

Clapp

2018

JSLS

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Background and Objectives:Rates of morbid obesity are skyrocketing worldwide. Not only bariatric surgeons, but also general surgeons are often operating on morbidly obese patients. Many general surgeons still use the same anatomic landmarks for patients with body mass index (BMI) over 35 mg/kg2 as they do for patients of normal weight and can therefore find accessing the morbidly obese abdominal organs difficult. This paper will describe a technique that is easily reproducible and applicable in a wide range of laparoscopic cases.Method:The xiphoid process is the only landmark referenced. From the xiphoid process, the surgeon puts 2 fists together and places the first trocar inferiorly 2 cm lateral to the midline in either direction. The umbilicus is not used as a landmark. This placement is 15–18 cm inferior to the xiphoid process, but allows adequate visualization for any foregut case. An optical trocar is used.Results:In over 1400 bariatric cases, the initial trocar was safely placed with this technique. Most of these cases were performed with the method, but some had one modification: the first trocar was placed in the midclavicular line in the subcostal area if there were previous midline scars. In no cases was an extra-long, or bariatric, trocar used.Conclusions:Laparoscopic access in morbidly obese patients does not have to be difficult. Using an optical trocar off the midline 15–18 cm below the xiphoid process will provide reliable, safe access in the morbidly obese patient, with excellent visualization of the target anatomy.

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Bladeless Direct Optical Trocar Insertion in Laparoscopic Procedures on the Obese Patient

Abstract: Results of the study suggest that direct optical entry technique reduced entry time and blood loss with trends to slightly decrease the occurrence of minor vascular and bowel injuries in obese women.

Cited by 41 publications

References 19 publications

Laparoscopic entry techniques: What is the controversy?

Laparoscopic entry techniques: What is the controversy?

A Randomized Controlled Trial Comparing Laparoscopic Access with the DTI and VNI

Optimal Initial Trocar Placement for Morbidly Obese Patients

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