Direct trocar insertion at laparoscopy: an evaluation.

The need for pneumoperitoneum before trocar entry in laparoscopy is evaluated. In over 2000 unselected cases performed in a residency training program from January 1979 to December 1982, three complications of bowel perforation and peritonitis occurred, one despite needle induction of pneumoperitoneum. In entering the abdomen directly with a trocar, critical surgical points are emphasized: adequate relaxation, sharp trocars, adequate skin incision, elevation of the abdominal wall, and insertion of the trocar into the true pelvis. For most patients with no previous abdominal surgery, the authors suggest that this technique offers more clinical security because it does not place reliance on secondary tests but emphasizes concentration entirely upon surgical skill and anatomic knowledge during entry.