English

Abstract

AIMS AND OBJECTIVES: The aim of our study was to compare the open and close technique of trocar insertion in terms of technique of insertion, patient's safety, intra operative complications and post operative complications. STUDY DESIGN: The present study was prospective, observational and longitudinal. Protocol of the procedure was formed along with Performa, Patient Information Sheet and Informed Consent Form. PLACE AND DURATION OF STUDY: The present study was carried out in surgery department of C.U Shah medical college, Surendranagar; Gujarat state. The study was carried out from 1 st October 2010 till 31 st August 2012. METHODOLOGY: A total of one hundred patients undergoing emergency and elective laparoscopic surgery were included in our study. Case records of patients was recorded in the Performa containing demographic details, size and site of trocar insertion, technique of trocar insertion, intra operative, early post operative and late post operative complications were noted. RESULTS: Out of 100 patients enrolled mean age was 29.87±14.13. Out of 100 patients in the study; 51 (51%) were Male and 49 (49%) were Female. In terms of on table complications; CO2 leakage is more in open technique of trocar insertion. Gastrointestinal injury is more in close method of trocar insertion. In terms of post operative complications; wound infection was common in open insertion technique. CONCLUSION: We would advocate the open technique of trocar insertion as a technique of choice in primary trocar insertion as it counts more on patient safety as compared to the close technique. INTRODUCTION: The rapid adoption of minimally invasive surgical techniques, by surgeons representing many specialities and varying degree of expertise, has introduced added challenges to reduce the rate of procedure related complications. The establishment of pneumoperitoneum requires the introduction of a sharp insufflating needle or trocar. It is during the insertion of primary trocar, most of the complications occur. There are mainly two techniques by which first trocar can be inserted. First is the close technique; where a spring loaded verses needle is placed intra abdominally without the aid of direct vision and then trocar is placed blindly after creation of pneumoperitoneum. Second is the open technique where under direct vision a blunt tipped trocar is introduced into the peritoneal cavity.