| March 2005 · Vol. 17, No. 3 LETTERS
Use towel clips to limit trocar injury
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Fast Track
“Nothing will change until patients are forced to put their money where their mouth is”
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Although I very much appreciated Dr. Michael Baggish’s article, “Avoiding vascular injury at laparoscopy” (October), I was disappointed that no mention was made of using towel clips to elevate the edges of the umbilicus while inserting the trocar or Veress needle perpendicularly through the base of the umbilicus.1 Since the base of the umbilicus is consistently the thinnest portion of the entire abdominal wall (approximately 1.4 cm, compared with 3 cm at the lower border of the umbilicus), it is the easiest area to traverse, even in obese patients.
Further, Dr. Baggish states, “When force is applied via trocar to the anterior abdominal wall, that structure is displaced toward the abdominal cavity in the direction of the posterior abdominal wall—even when countertraction is taken into consideration.” He estimates that displacement to be 5 cm or more. However, his statement is accurate only when the countertraction is a hand grabbing the abdominal skin. It is not true when the countertraction is provided by towel clips on the umbilicus.
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