A NEW TECHNIQUE OF PRIMARY TROCAR INSERTION FOR LAPAROSCOPY

A new method of primary trocar insertion exploits the anatomy of the a nterior abdominal wall at the umbilicus. The point of fusion between t he skin, fascia, and peritoneum is identified and a tiny incision is m ade precisely over this point, enabling a small clamp to be introduced directly into the peritoneal cavity. After stretching the opening wit h this clamp, a 5-mm trocar is introduced into the peritoneal cavity o ver a blunt probe, and the abdomen is insufflated. The opening is stre tched further with a Kelly clamp, and a 10-mm trocar is introduced ove r a blunt probe. The technique was used in 54 consecutive patients, 20 of whom had prior low vertical incisions. Ten women had very dense pe riumbilical adhesions, placing at least four at extremely high risk of bowel injury from blind entry. There were no injuries, and the techni que is so quick and effective that it is now the author's routine meth od of trocar insertion for laparoscopy.