COMPARISON OF VISUAL AND TACTILE LOCALIZATION OF THE TROCAR TIP DURING ABDOMINAL ENTRY

We attempted to determine whether video-aided visual imaging during la paroscopic insertion of the trocar would improve the surgeon's ability to localize the sharp penetrating tip of the instrument. A newly desc ribed, visually directed laparoscopic trocar was inserted in 184 subje cts to correlate visual localization of the tip with the accuracy of t he conventional tactile sensory approach. In 164 of the 184 cases the fascia was recognized visually at the same time that the surgeon ackno wledged tactile resistance. However, partial intraabdominal penetratio n was noted in 102 of these cases just before the anticipated loss of resistance could be felt manually. More important, in 20 women there w as no subjective manual confirmation of the tip location by the time i ntraabdominal placement of the trocar was confirmed visually. In this limited series there were no multiple insertions or complications unde r visually directed trocar entry. Video-aided direct visualization imp roves the surgeon's ability to localize the tip of the trocar througho ut the insertion. It may help the surgeon to recognize and possibly av oid some inadvertent distant intraabdominal organ injuries.