| June 2005 · Vol. 17, No. 6 LETTERS
Optical-access trocars: Good idea or higher risk?
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Fast Track
“There have been numerous reports of injury utilizing these ‘safer’ optical trocars”
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I read with interest the 2 recent articles on laparoscopic surgery: “Avoiding vascular injury at laparoscopy,” by Michael Baggish, MD (October 2004), and “Laparoscopic surgery in the obese: Safe techniques,” by James K. Robinson III, MD, and Keith B. Isaacson, MD (March 2005).
Although complications from the use of optical-access trocars have been briefly described, I believe primary trocar insertion under direct visualization (video) is safer than “blind” or “open” techniques. Using an optical-access primary trocar, an experienced laparoscopist can clearly identify the subcutaneous tissue, fascia, and peritoneum, allowing for a more controlled and “thrustless” insertion into the peritoneal cavity. Even when extensive intraperitoneal adhesions are present, peritoneal windows can be identified by direct visualization.
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