A TECHNIQUE FOR NEEDLE INSUFFLATION IN OBESE PATIENTS

Creation of pneumoperitoneum as the first step in closed laparoscopy a nd the insertion of a primary trocar are the only ''blind'' steps in l aparoscopy. These steps have occasionally been associated with technic al difficulties and complications and with prolonged operative time. T hese problems are compounded in obese patients. In this report, we des cribe a simple and safe technique for needle insufflation and insertio n of a primary trocar. With this technique, instead of lifting and ele vating the anterior abdominal wall by grasping the skin and panniculus adiposus with hands or tennaculae, the abdominal fascia is grasped wi th two Kocher clamps and then lifted and held immobile during needle a nd trocar insertion. This maneuver provides much better visual and tac tile control and is done more expeditiously, particularly in obese pat ients.