Direct laparoscope trocar insertion without prior pneumoperitoneum

J Reprod Med. 1978 Jul;21(1):45-7.

Abstract

The results of direct trocar insertion without prior establishment of pneumoperitoneum are documented in 301 consecutive laparoscopies. No complications or technical failures attributable to the method were encountered. A reduction of complications associated with needle-induced pneumoperitoneum may be possible with this method.

PIP: The author questions the conventional assumption that the pneumoperitoneum must be established before insertion of the laparoscope and its trocar. Complications commonly associated with establishment of a needle-induced pneumoperitoneum include subcutaneous emphysema, blood vessel penetration, retroperitoneal emphysema, bowel distention, overdistention, gas embolism, and omental emphysema. This paper summarizes the author's experience with 301 outpatient laparoscopies performed in 1976-77 using the method of direct trocar insertion without prior pneumoperitoneum. The process of pneumoperitoneum was visualized directly through the Needlescope. 54 cases were performed under general anesthesia and 247 under local anesthesia. Complications were encountered in only 3 cases (1 uterine perforation and 2 cases requiring postoperative hospitalization for nausea and vomiting). There were no cases of technical failure. Comparison of recovery times for 250 consecutive patients treated without preliminary pneumoperitoneum and 117 patients treated with the conventional technique indicated that the recovery time was 19 minutes shorter on average in the former group because of a lessened degree of postoperative discomfort, nausea, and vomiting. Although further research is necessary to confirm the findings in this series, it seems plausible to suggest that a reduction of complications associated with needle-induced pneumoperitoneum may be possible with this technique.

MeSH terms

  • Female
  • Humans
  • Laparoscopy / adverse effects
  • Laparoscopy / methods*
  • Pneumoperitoneum, Artificial*