|
A larger bore (11-12mm diameter) trocar is generally placed through the abdominal wall once a pneumoperitonuem (gas filled abdominal and pelvic cavity) is created with the Verres needle. Care should be exercised to limit injury to the underlying intra-abdominal organs. There are types of trocars (such as the Visiport trocar) that allow a surgeon to directly visualize the (abdominal wall) tissues being entered. Standard disposable trocars often have a protective sheath that snaps into place over the cutting blade of the trocar once there is entry into the abdominal cavity.
I usually hold up on the umbilical (belly button) tissue while placing the trocar slowly and carefully. I always try to stop entry of the trocar at the very point where the sheath enters the abdominal cavity so as to limit the possibility of injury. If the patient has a high risk of intra abdominal adhesions, I often use a Visiport trocar or an open laparoscopy technique. During open laparoscopy, the surgeon cuts down the tissue layer by layer under direct visualization until entry is achieved.
|
|