| July 2005 · Vol. 17, No. 7 LETTERS
The “ins” and outs of trocar insertion
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Fast Track
“Attempt direct trocar insertion (no pneumoperitoneum) with great caution when using a disposable device”
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The exchange of letters in the June issue was provocative (“Optical-access trocars: Good idea or higher risk?”). In my experience, direct trocar insertion is safer and saves time. Transumbilical insertion is best because the umbilicus is the thinnest part of the abdominal wall and the peritoneum is firmly attached to it, but trans-culde-sac insertion using a Veress needle is the better option if abdominal insertion is not possible in extremely obese patients.
In addition, in prolonged procedures, nitrous oxide makes a safer insufflation medium because it lacks the biochemical side effects of carbon dioxide. In fact, direct trocar insertion with nitrous oxide insuffla-tion and a single-puncture laparoscope is an ideal setup in average, low-risk patients undergoing minor procedures under local and/or intravenous mild sedation and no uterine manipulation.
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