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Initial Laparoscopic Access Using an Optical Trocar Without Pneumoperitoneum Is Safe and Effective in the Morbidly Obese

Department of Surgery, University of California San Francisco, California

Francesco Palazzo, MD

Department of Surgery, University of California San Francisco, California

Hisae Aoki, MD

Department of Surgery, University of California San Francisco, California

Guilherme M. Campos, MD, FACS

Department of Surgery, University of California San Francisco, California, camposg{at}surgery.ucsf.edu

Obtaining access to the peritoneal cavity in laparoscopic surgery is more difficult in morbidly obese people. The aim of this study was to examine the safety and efficacy of accessing the peritoneal cavity using an optical, bladeless trocar without previous pneumoperitoneum in morbidly obese patients. The patients' characteristics and outcomes with consecutive and preferential use of an optical, bladeless, first trocar insertion without previous pneumoperitoneum in morbidly obese patients (body mass index > 35 kg/m²) was reviewed. A total of 208 morbidly obese patients were included. The trocar insertion technique was used in 196 patients. No bowel or major abdominal vessel injuries occurred. Ninety-eight patients (50%) had previous abdominal operations. Trocar-related injuries occurred in 3 patients: a superficial mesenteric laceration in 2 and a laceration of a greater omentum vessel in 1. The direct first trocar insertion technique provides safe entry into the peritoneal cavity in morbidly obese patients.

Key Words: laparoscopic surgery • morbid obesity • trocar insertion • trocar injury • optical trocar

This version was published on June 1, 2008

Surgical Innovation, Vol. 15, No. 2, 126-131 (2008)
DOI: 10.1177/1553350608317354


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