INTRODUCTION: The purpose of the study was to compare the ease of use, safety, and efficacy of direct trocar insertion (DTI) and open access (Hasson technique) in laparoscopic surgery. This is the first known report of DTI used in urolaparoscopy.
METHODS: The study was a retrospective evaluation of patients referred for laparoscopic procedures between December, 2005 and June, 2008. A total of 148 patients were studied; 62 patients (41.9%) received DTI and 86 patients (58.1%) received open laparoscopy. Patients were not randomly assigned to treatment groups. For the DTI, the abdominal wall was lifted and the trocar was pushed through the fascia and muscle layer. The surgeon felt when the trocar had pierced the peritoneum and entered the abdominal cavity. For the open technique, the peritoneal cavity was opened under direct vision and the trocar was inserted. The variables measured were access time, minor and major complications, visceral and vascular injury and bleeding, conversion to open surgery, length of hospitalization, failed entry, and abdominal pressure for creation of the pneumoperitoneum. Chi-square and t tests were used to compare categorical and continuous variables, respectively.
RESULTS: The mean length of hospitalization was 26.95 hours (SD = 7.78) for patients receiving DTI and 30.44 hours (SD = 13.98) for patients receiving open laparoscopy, but the difference was not statistically significant (P > .05). The mean access time for DTI was 91.75 seconds (SD = 79.77), which was significantly shorter than the mean access time of 263.97 seconds (SD = 119.28) for patients receiving open laparoscopy (P < .0001). The mean abdominal pressure for creation of the pneumoperitoneum with DTI was 16.17 mmHg (SD = 1.46), which was significantly higher than the mean abdominal pressure of 15 mmHg (SD = 0) with open laparoscopy (P < .0001). There were very few complications in either study group. Although 11 patients (17.74%) in the DTI group and 7 patients (8.14%) in the open laparoscopy group had previous open abdominal or groin surgery, the previous surgeries did not negatively impact the laparoscopic procedures (P = .01). There were no entry failures in either group.
CONCLUSION: DTI is faster and appears to be more efficacious for some aspects of surgery than the open laparoscopy technique, although the safety of the two techniques is equivalent. The authors suggest that direct trocar insertion can be used in urolaparoscopic surgeries. Future prospective studies with larger numbers of patients randomly assigned to treatment groups are needed to confirm the results.
KEYWORDS: Laparoscopic surgery; Direct trocar insertion; DTI; Laparoscopic access; Pneumoperitoneum; Emphysema; Urolaparoscopy; Endopth Xcel trocar
CITATION: UroToday Int J. 2009 Dec;2(6). doi:10.3834/uij.1944-5784.2009.12.03.