Does the use of pneumoperitoneum and disposable trocars prevent bowel injury at laparoscopy? A randomized experimental study in the rabbit

Abstract

Objectives The purpose of this experimental study was twofold. The first aim was to compare the incidence of bowel injury after prior insufflation using the Veress needle versus direct trocar insertion, and the second aim was to compare bowel injury with the use of disposable versus reusable trocars, in animals with or without prior abdominal surgery. Design A total of 80 mature New Zealand rabbits (2400–3000 g) were randomly assigned to one of two experimental groups, with (n=40) or without (n=40) prior standardized peritoneal trauma. In each group, four subgroups (n=10 each) were constituted by randomly assigning the animals to initial insufflation using the Veress needle or direct trocar insertion and/or to reusable or disposable trocar insertion. Each animal underwent five trocar insertions. The number of bowel injuries was assessed by laparotomy. Results As expected, the presence of experimentally induced abdominal wall adhesions significantly increased (P=0.0001) the incidence of bowel injury. When abdominal wall adhesions were present, the number of perforations was lower if initial insufflation had been performed compared with those in whom direct trocar insertion was carried out (P=0.03). There was no statistical difference in the rate of injury between disposable and reusable trocars when abdominal wall adhesions were present. However, in those without abdominal wall adhesions, the use of disposable trocars significantly decreased (P=0.04) the risk of bowel injury. Conclusions The presence of abdominal wall adhesions increased the rate of bowel injury at laparoscopy. In the cases with prior abdominal surgery and abdominal wall adhesions, initial insufflation was safer than direct trocar insertion, but the use of disposable trocars did not improve the safety of the procedure. In the absence of prior abdominal surgery, initial insufflation using the Veress needle did not prevent bowel injury; however, in this group the use of disposable trocars proved safer than the use of reusable trocars.