Direct insertion of the laparoscopic trocar after an earlier laparotomy
Kaali, S.G.; Bartfai, G.
Journal of Reproductive Medicine 33(9): 739-740
1988
ISSN/ISBN: 0024-7758 PMID: 3172079 Document Number: 362312
Direct insertion of the trocar at laparotomy without prior establishment of pneumoperitoneum with the Verres needle has long been considered inadvisable in patients with previous abdominal surgery because of problems caused by adhesions. However, direct insertion of the trocar affords the advantages of immediate observation, shorter observation, shorter operative time, and less postoperative discomfort. Between 1984 and 1987, 1670 laparoscopies were performed at the Women's Medical Pavilion, Dobbs Ferry, New York--1616 for sterilization and 54 for diagnostic purposes. 416 of the women had had prior abdominal surgery, and 47 had intraabdominal or pelvic adhesions. Only 1 of the 416 previous surgery patients suffered complications, and these were not related to adhesions. It is concluded that direct insertion of the laparoscopic trocar can be successfully done even on patients with previous abdominal surgery.