Direct Trocar Insertion: A Safe Laparoscopic Access

Background: The most important and potentially dangerous first step in laparoscopy is safe and successful insertion of a primary port. Techniques for the creation of pneumoperitoneum at laparoscopy include the standard technique of insufflation after insertion of the Veress needle (VN) via the umbilicus, open laparoscopy, optical trocar insertion and direct trocar insertion (DTI) as well as variations on these techniques. The DTI technique without pre-insufflation is an alternative to VN insertion and open laparoscopy for accessing the abdominal cavity for operative laparoscopy. It recommends elevation of anterior abdominal wall with the non-dominant hand while inserting the sharp primary trocar directly and blindly towards the peritoneal cavity with the other. Conclusion: After reviewing the methods available and surveying the existing data concerning the rates of failure and complications, we conclude that, DTI at laparoscopy is a safe alternative to the VN technique and is associated with fewer minor complications.