Page 49 - Journal of Laparoscopic Surgery - WALS Journal

WJOL S
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10.5005/jp-journals-10033-1271
Laparoscopic Entry: A Hybrid Technique of Open Hasson and Direct Trocar Access
PHOTO ASSAY

Laparoscopic Entry: A Hybrid Technique of Open

Hasson and Direct Trocar Access

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1 Sadashivayya S Soppimath, Chiniwalar Srishail, Praveen Padasali
3
ABSTRACT TECHNIQUE
The first trocar entry for creating pneumoperitoneum is a very • A midline vertical supraumbilical/infraumbilical
crucial step in minimizing complications and completing the pro- incision is made for 1 to 1.5 cm long with a 15 no
cedure laparoscopically. Various methods have been described,
among which Veress and open Hasson technique are widely surgical knife (Fig. 1).
used. Here we describe a novel and hybrid technique of com- • The subcutaneous layers are opened upto the linea
bining open Hasson and direct trocar with several advantages. alba either using the knife or bluntly with artery
Keywords: Entry, Laparoscopy, Technique. forceps (Fig. 2).
How to cite this article: Soppimath SS, Srishail C, Padasali P. • The linea alba is opened vertically (7–8 mm) till the
Laparoscopic Entry: A Hybrid Technique of Open Hasson and peritoneal layer. It is necessary to open the linea alba
Direct Trocar Access. World J Lap Surg 2016;9(1):47-49. in midline (Figs 3 and 4).
Source of support: Nil
Conflict of interest: None

INTRODUCTION

Laparoscopy as a minimally invasive technique has
many advantages for both the patient and the surgeon.
As the armamentarium of laparoscopy is widening,
the need to reduce complications and make it safe and
easy to learn even for newcomers is a constant work in
progress. The first trocar entry is a very important step
in minimizing the complications and in completing the
1
procedure laparoscopically. There have been numerous Fig. 1: Skin incision (supraumbilical)
techniques described for easy and safe access into the
abdominal cavity for creating a pneumoperitoneum. Many
surgeons use the Veress or the open Hasson technique,
and with experience the ease of doing it is acquired, but
the difficulty level in the initial few cases remains with
both the techniques, and rarely even experienced surgeons
face difficulty in few cases with these techniques. So, here
we describe a hybrid technique of open and direct trocar
access i.e., easy to get access into the abdomen, safe for the
patient with minimal complications, and straightforward
for any newcomer to learn and teach others.
Fig. 2: Linea alba visualized

1 Associate Professor, Consultant
2,3
1 Department of Surgery, SDM College of Medical Sciences
and Hospital, Dharwad, Karnataka, India
2 Department of Surgical Gastroenterology, Suchirayu Hospital
Hubballi, Karnataka, India
3 Department of General Surgery, Suchirayu Hospital, Hubballi
Karnataka, India
Corresponding Author: Srishail Chiniwalar, Consultant
Department of Surgical Gastroenterology, Suchirayu Hospital
Hubballi, Karnataka, India, Phone: +918362239000, e-mail:
drsrichinni@gmail.com
Fig. 3: Linea alba incised
World Journal of Laparoscopic Surgery, January-April 2016;9(1):47-49 47