Direct Trocar Insertion without Pneumoperitoneum and the Veress Needle in Laparoscopic Cholecystectomy: a Comparative Study

Prieto-Díaz-Chávez, Emilio; Medina-Chávez, José Luis; González-Ojeda, Alejandro; Anaya-Prado, Roberto; Trujillo-Hernández, Benjamı́n; Vásquez, Clemente

doi:10.1080/00015458.2006.11679948

Cited by 27 publications

(20 citation statements)

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“…This is in agreement with the observations of Borgatta et al [26] , Olvera and Gomez [30] , Rahman and Mamun [18] , Inan et al [31] , and Prieto-Díaz-Chávez et al [32] .…”

Section: Discussionsupporting

confidence: 83%

Direct Trocar versus Veress Needle Entry for Laparoscopy: A Randomized Clinical Trial

Zakherah¹

2010

Gynecol Obstet Invest

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Aims: To compare direct trocar (DT) to Veress needle (VN) entry for the creation of pneumoperitoneum during laparoscopy with regard to the duration of the procedure, volume of gas used, ease of performance, and frequency of complications. Design: A randomized clinical trial. Subjects and Methods: One thousand patients scheduled to undergo diagnostic laparoscopy were recruited for the study. They were randomly allocated to either DT entry (group A, n = 500) or VN (group B, n = 500) for pneumoperitoneum. The laparoscopic procedures were performed by the same surgeon. Outcomes: The duration of the procedure, volume of gas consumption, ease of performance and frequency of complications were analyzed. Results: Patients in the 2 groups had similar demographic characteristics. The mean duration of the procedure was significantly shorter in group A (2.2 ± 0.7 min, 95% CI 2.14–2.26) than in group B (8.2 ± 1.4 min, 95% CI 8.08–8.32; p < 0.0001). The mean gas consumption was significantly less in group A (2.6 ± 0.9 liters, 95% CI 2.52–2.68) than in group B (8.4 ± 2.6 liters, 95% CI 8.17–8.63; p < 0.0001). No major complications in both groups were encountered. Minor complications were significantly less in group A (0.4%, 95% CI 0.77–3.23) than in group B (14%, 95% CI 10.96–17.04; p < 0.0001). Conclusions: DT entry is a safe alternative to the VN entry technique for the creation of pneumoperitoneum. Such an approach has further advantages such as less cost and instrumentation and rapid creation of pneumoperitoneum.

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“…This is in agreement with the observations of Borgatta et al [26] , Olvera and Gomez [30] , Rahman and Mamun [18] , Inan et al [31] , and Prieto-Díaz-Chávez et al [32] .…”

Section: Discussionsupporting

confidence: 83%

Direct Trocar versus Veress Needle Entry for Laparoscopy: A Randomized Clinical Trial

Zakherah¹

2010

Gynecol Obstet Invest

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“…In 2006 Cakir [7] from Turkey emphasized from his study that the Veress needle has not been identified as a component of organ injury and that the Veress needle method is safe. In 2006 Chávez [8] from Mexico reviewed the use of the Veress needle and direct trocar entry method in laparoscopic cholecystectomy; it was seen that the Veress needle method had a higher complication rate and took longer time than the direct trocar entry method. Chávez also emphasized that the direct trocar entry method was a safe, fast and effective method.…”

Section: Discussionmentioning

confidence: 99%

Direct Trocar Entry For Laparoscopy Safety and Efficiency

Ulusoy¹

2018

Laparosc Endosc Surg Sci

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“…is that it takes less time to establish pneumoperitonium. Prieto et al (18) reported a laparoscopic insertion time that was significantly different between two techniques (D.T.I. 1.5 +_ 0.5 versus V.N.…”

Section: Discussionmentioning

confidence: 99%

Pneumoperito Neum by Direct Trocar Insertion : Safe Laparoscopic Access

Kumar¹,

Hastir²,

Bandlish³

2015

jemds

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Purpose of this study is to access the safety and efficacy of direct trocar insertion (DTI) for accessing the abdominal cavity for operative laparoscopy without prior pneumoperitoneum. DTI is one of the safe and effective alternative to veress needle insertion, open access (Hassan's technique) and visual entry systems (disposable optic trocars and endotip visual cannula) in laparoscopic surgery. METHODS: The study included 2480 patients who has undergone laparoscopic procedures at civil hospital, Jalandhar from Nov. 2003 to Sept. 2012 and at Punjab Institute of Medical Sciences (PIMS) Jalandhar from Sept. 2012 to June 2014. Procedures include 2310 laparoscopic cholecystectomies, 148 laparoscopic appendectomies, 10 cases of TAPP Groin hernia repairs and 12 cases of simple ovarian cysts. For DTI, abdominal wall was lifted and trocar was pushed through the fascia and muscle layer. The surgeon felt click when the trocar had pierced the peritoneum and entered the abdominal cavity. RESULTS: Direct trocar insertion was feasible in 100% of patients. There was no evidence of intestinal or vascular injury during trocar placement. Peritoneal access and creation of laparoscopic workspace were attained faster and more efficiently by the DTI technique. CONCLUSIONS: DTI is a fast, safe and reliable alternative to traditional techniques of primary port placement in laparoscopic procedures for creation of pnuemoperitoneum. KEYWORDS: Direct trocar insertion (DTI), Pneumoperitoneum, veress needle (VN), Laparoscopy. INTRODUCTION:The establishment of pneumoperitoneum is a pre-requisite for most laparoscopic surgeries and the method used is not necessarily dependent on the procedure for which it is intended. Over the last decade rapid increase has occurred in both the applications of operative laparoscopy and the number of surgeons using this technique. Laparoscopic abdominal surgery requires the establishment of successful pneumoperitoneum in the vast majority of patients with more than half of all the complications occurring at the time of entry into abdomen.The rationale for an adequate pneumoperitoneum is that it provides buffer space between the insertion site and pelvis or abdominal viscera. Several techniques and technologies have been introduced over the past 50 years to minimize laparoscopic related injuries. The standard technique of insufflation after insertion of Veress needle, open laparoscopy involving opening of the peritoneum under direct vision (Hasson's method), optical trocar insertion and direct trocar insertion (DTI) as well as variants of these techniques.Recent experiences with laparoscopy has revealed significant complication associated with Veress needle insufflation such as gas embolism, subcutaneous emphysema, failed pneumoperitoneum with resultant failed laparoscopy and bowel and visceral insufflations. (1, 2) Open assess as described by Hasson in 1971 (3) has shown to minimize vascular injuries but does not reduce bowel injury. Also open access is complicated by gas leak and port instability.

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Direct Trocar Insertion without Pneumoperitoneum and the Veress Needle in Laparoscopic Cholecystectomy: a Comparative Study

Abstract: Our results show DTI to be a safe, efficient, rapid and easily-learned alternative technique, reducing the number of procedure-related complications.

Cited by 27 publications

References 0 publications

Direct Trocar versus Veress Needle Entry for Laparoscopy: A Randomized Clinical Trial

Direct Trocar versus Veress Needle Entry for Laparoscopy: A Randomized Clinical Trial

Direct Trocar Entry For Laparoscopy Safety and Efficiency

Pneumoperito Neum by Direct Trocar Insertion : Safe Laparoscopic Access

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