Laparoscopic Entry Using Direct First Trocar Insertion without a Prior Pneumoperitoneum: A Prospective Cohort Study

Purpose: This study aimed to assess safety, feasibility, complications, and time of direct first trocar insertion (DFTI) with carbon dioxide (CO 2 ) insufflation and operating time in laparoscopic surgery. Materials and methods: This study was a prospective cohort study (clinical original) performed at AL-Karama Teaching Hospital/College of Medicine, Wasit University, Iraq, from April 2011 to December 2017. The study enrolled 687 patients prepared for different laparoscopic procedures using direct first trocar insertion techniques for laparoscopic entry. Conversion of laparoscopic entry to Veress needle (VN) or open technique was performed when direct first trocar insertion technique failed. Recorded data were age, sex, indications for laparoscopic surgery, time of direct first trocar insertion with CO 2 -insufflation,operating time, and direct first trocar insertion-related complications. Results: Direct first trocar insertion technique was successful in 684 (99.57%) patients and failed in 3 patients when trocar entry was converted to Veress needle technique. These three patients were excluded from the statistical analysis of the study data. Demographic distribution of the patients was as follows: 90 (13.2%) males and 594 (86.8%) females. This study had no major complications, while minor complication rate was 1.31%. Mean ± standard deviation (SD) of direct first trocar insertion with CO 2 -insufflation time for males, females, and total patients was 2.32 ± 0.57 minute (m), 1.89 ± 0.53 m, and 1.95 ± 0.56 m, respectively. p value was 0.03 and was statistically significant. This study had no mortality. Conclusion and clinical significance: Direct first trocar insertion is a safe and cost-effective laparoscopic entry technique. It has a high feasibility rate, low complication rate, fast laparoscopic entry, and fast creation of pneumoperitoneum.