Evaluation of the direct trocar insertion technique at laparoscopy.

A technique using direct trocar insertion for laparoscopy was introduced into the Tripler Army Medical Center Obstetrics and Gynecology training program in September 1982. From January 1, 1983 to December 31, 1985, a total of 1249 laparoscopic procedures were performed. Detailed records of 937 laparoscopic procedures performed using this technique were reviewed. The technique was used with increasing frequency: 40% in 1983, 85% in 1984, and 96% of all laparoscopies in 1985. There were no major complications. With increased departmental experience, the frequency of minor complications decreased: 5.3% in 1983, 5.0% in 1984, and 1.3% in 1985. Obesity was associated with a significantly increased risk of minor complications (P less than .001). A history of abdominal surgery was not associated with an increased risk of minor complications. Surgical skill level was not associated with the complication rate.