Peritoneal hyperdistention for trocar insertion

Abstract

IntroductionMost laparoscopic complications occur at the time of Veress needle and trocar insertion. Although they are not very frequent, they increase the morbidity and mortality of both diagnostic and operative laparoscopic procedures. The currently recommended techniques of trocar insertion have not completely eliminated the risk of injury.TechniqueAfter Veress needle insertion we recommend creating peritoneal hyperdistention up to 25–30 mmHg pressure. At this point a short trocar is inserted in the deepest part of the umbilicus without elevation of the anterior abdominal wall. The result is a parietal peritoneal puncture directly beneath the umbilicus. As soon as safe abdominal entry is established, the pressure is lowered to 15 mmHg.ExperienceIn our large series utilizing peritoneal hyperdistention there was but one vascular bowel injury related to umbilical trocar insertion. Maintaining an increased intra‐abdominal pressure for the length of time required for trocar insertion did not result in patient morbidity.ConclusionPeritoneal hyperdistention at trocar insertion is safe and may reduce the rate of trocar‐related complications.