A randomized, prospective trial was designed to compare direct trocar insertion with prior peritoneal insufflation with a Verres needle for laparoscopic tubal sterilization. Direct trocar insertion resulted in fewer instrument insertions (21.8% vs. 7.8%) and use of smaller volumes of CO2 (2.67 vs. 2.32 L). Direct trocar use resulted in a decrease in operating time from 9 minutes, 40 seconds in the needle group to 7 minutes, 30 seconds in the trocar group. Minor omental injuries occurred in a small percentage of each group, while serious complications occurred once in each group.
PIP: The results of using immediate trocar insertion were compared to prior peritoneal insufflation with a Verres needle for laparoscopic tubal sterilization, with respect to total operative time, number of instrumental insertions, volume of CO2 required and complications. 102 women had a direct trocar procedure; 110 the prior needle insertion, selected randomly. Laparoscopy was done with a single-puncture instrument, triple cautery, and upper abdominal inspection under video control. Times were noted from the incision for the Verres needle to trocar insertion, from trocar incision to confirmation of correct placement of the laparoscope, and from then until cutting of the last suture. Total operating time was less in the direct trocar group, 7 minutes 30 seconds, vs. 9 minutes 40 second, p0.0001. 8 women in the direct trocar group had multiple trocar insertions, compared to 24 women in the needle group. The direct trocar group received less CO2, 2.32 L compared to 2.67 for the needle group, p0.001. There were minor injuries to the omentum not requiring intervention in 7 women in the needle group, but 4 in the trocar group. There were 2 complications: a woman in the direct trocar group had to have laparotomy because of insertion of the trocar into the large bowel, which was adherent to the abdominal wall. Another woman in the needle group returned 3 days later with pain, fever and ileus, and recovered after treatment. These observations suggest that direct trocar insertion is safer for patients in terms of operative time, need for additional CO2, and especially risk of multiple instrument insertions, always a blind procedures with potential for injury.