Original ArticlesDirect Trocar Insertion Technique for Initial Access in Morbid Obesity Surgery: Technique and ResultsAltun, Hasan MD*; Banli, Oktay MD†; Karakoyun, Rojbin MD‡; Boyuk, Abdullah MD†; Okuducu, Mehmet MD*; Onur, Ender MD*; Memisoglu, Kemal MD*Author Information *Department of General Surgery, Fatih Sultan Mehmet EA Hospital, Istanbul †Department of General Surgery, Elazig EA Hospital, Elazig ‡Department of General Surgery, Ataturk Sanatoryum Hospital, Ankara, Turkey Reprints: Dr Hasan Altun, MD, Fatih Sultan Mehmet EA Hastanesi, 34752 Bostanci—Istanbul, Turkey (e-mail: [email protected]). Received for publication November 23, 2009; accepted April 19, 2010 Surgical Laparoscopy, Endoscopy & Percutaneous Techniques: August 2010 - Volume 20 - Issue 4 - p 228-230 doi: 10.1097/SLE.0b013e3181ec6667 Buy Metrics Abstract Purpose Obtaining access to the peritoneal cavity in laparoscopic surgery is more difficult in morbidly obese patients. There is no clear consensus as to the optimal method of entry into the peritoneal cavity. This study assesses the safety and feasibility of the direct trocar insertion technique without pre-existing pneumoperitoneum in patients undergoing laparoscopic bariatric surgery. Methods From February 2006 to July 2009, 155 morbidly obese patients underwent laparoscopic adjustable gastric band surgery. There were 128 women (82.6%) and 27 men (17.4%). The mean age was 41 and ranged between 18 and 59 years. Results All patients met the National Institutes of Health criteria for bariatric surgery. The mean body mass index was 45 kg/m2 (range 35 to 61). There was no evidence of intestinal or vascular injury during trocar placement. Immediate minor complications were extraperitoneal insufflations in 5 patients, gastric serosal laceration in 1 patient, and left liver lobe laceration in 1 patient. No major complications were associated with this technique. Conclusions All complications related to the direct trocar insertion technique were minor and these complications did not affect the success of surgery. We concluded that the direct trocar technique for initial access in laparoscopic bariatric surgery provides safe and quick entry into the peritoneal cavity. © 2010 Lippincott Williams & Wilkins, Inc.