Transumbilical direct trocar entry for operative videolaparoscopy

Objectives: Complications associated with initial abdominal entry are a prime concern for laparoscopic surgeons. We describe our technique of transumbilical direct trocar entry and evaluate the effectiveness and safety of this approach to primary trocar entry based on over 5 years’ experience. Study design: Complications were reviewed by retrospective consecutive review of charts of patients who underwent operative laparoscopy. Methods: Between September 1993 and January 1999, 1,027 patients underwent 2,251 operative laparoscopic procedures at Stanford University Medical Center, a tertiary care facility. Nine-hundred-eighteen patients underwent transumbilical direct trocar entry. One hundred and nine patients considered to be at high risk for intraabdominal adhesions underwent initial pneumoperitoneum using Veress needle prior to initial trocar placement. Laser treatment of endometriosis, adhesiolysis, and myomectomy (laparoscopic and laparoscopic-assisted) represented 1,543 (68.5%) of the procedures performed. Results: Complication rates associated with primary trocar placement were evaluated. No major complications were observed. Two of 918 patients who underwent transumbilical direct trocar placement experienced umbilical infections. Conclusion: Transumbilical direct trocar placement is a safe and effective method of primary trocar entry.