Vol. 9, Issue 1, Part A (2025)
Assessment of direct trocar insertion in patients undergoing laparoscopic procedures
Ahmed Sabah Hameed and Hayder Sabah Saleem Al Kawaz
Background: The Veress needle technique is widely used for establishing pneumoperitoneum in laparoscopic surgery but is associated with complications. Direct trocar insertion is an alternative method, potentially avoiding these complications.
Aim of the study: This study evaluates the safety and feasibility of direct trocar insertion without prior pneumoperitoneum in laparoscopic procedures.
Methods: An observational study involving 103 patients was conducted from February 2020 to May 2021 at Al-Yarmouk Teaching Hospital and private hospitals in Baghdad, Iraq. The study included patients undergoing elective and emergency laparoscopic procedures for gallstones, acute appendicitis, and ovarian cysts. A 12-mm skin incision was made, and a disposable 12-mm trocar was directly inserted into the peritoneal cavity using a twisting motion. Pneumoperitoneum was then established. Patients were followed up for six months to monitor postoperative complications.
Results: Of the patients, 17 were male and 86 females, mostly aged 40-49 years. Gallstones were diagnosed in 88.4%, acute appendicitis in 8.7%, and ovarian cysts in 8.7%. Direct trocar insertion was feasible in 95.14% of cases. Surgery duration ranged from 30 to 120 minutes for gallstones and 35 to 55 minutes for appendicitis and ovarian cysts. The mean trocar insertion time was 1.6±0.566 minutes, with males requiring significantly more time (p=0.018). Complications included omental injury (3 cases), bleeding (1 case), hematoma (2 cases), CO₂ leakage (2 cases), and infection (4 cases).
Conclusion: Direct trocar insertion without prior pneumoperitoneum is a rapid, safe, and efficient technique with a low complication rate, suitable for surgeons trained in laparoscopic cholecystectomy.
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