Novel Technique for Safe Primary Trocar Insertion in Laparoscopy: Chou's Method

Summary 

Objective

To report a novel method to minimize major vascular injury during laparoscopic entry and to audit its safety.

Materials and Methods

A novel method (Chou's method) for primary insertion of a reusable conical trocar was applied at a tertiary-referral medical center in a cohort study of women undergoing laparoscopic surgery for gynecologic indications between March 1991 and March 2004. This method uses the unique concept of directly holding the fascia. Complications related to primary trocar insertion, including vascular and visceral injury, were audited.

Results

A consecutive series of 2,963 laparoscopic surgeries performed by the author was studied. No major vascular injury, fascial dehiscence, or hernia was encountered. Two entries failed due to inability to ensure an intraperitoneal location of the trocar because of extensive adhesions; these operations were converted to laparotomy. Eight serosal abrasion injuries of the intestines (0.27%) in severe adhesion cases and one abrasional injury to the gastric serosa (0.034%) were encountered, but fortunately none were severe and all patients recovered uneventfully without repair.

Conclusion

The results with this novel method incorporating the unique concept of directly holding the fascia suggest it to be relatively safe, simple, and economic. The risk of major vascular injury was decreased to nil by this technique and the chance of visceral injury was also minimal.

Key Words:  laparoscopy , major vascular injury , primary laparoscopic entry , trocar insertion

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