Berch BR et al. (2006) Experience with the optical access trocar for safe and rapid entry in the performance of laparoscopic gastric bypass. Surg Endosc 20: 1238–1241

Injury to intra-abdominal structures is a common complication of laparoscopic surgery that is usually caused by blind insertion of trocars. Some surgeons insert the first trocar using an 'open' minilaparotomy incision, but this technique is time-consuming and associated with air leaks in obese patients, and does not obviate the risk of bowel injury. To decrease the risk of such adverse events, optical access trocars have been developed that allow for the layers of the abdominal wall to be visualized during placement.

Berch and colleagues have now reported on a single surgeon's experience using the Optiview® trocar (Ethicon Endosurgery, OH, USA) for 327 laparoscopic gastric-bypass operations that were performed on morbidly obese patients. Access was successfully obtained with this device in all patients, without air leaks, and it gave excellent visualization. No adverse events were reported over a median follow-up period of 18 months (i.e. there were no port-site hernias and no trocar-related viscus or vascular damage). The time taken to insert the optical access trocar was only recorded in 10 patients, in whom the mean time taken was 28 s ± 1.2 s.

The very low complication rate reported in this study is consistent with other published reports that describe use of the optical access trocar. The authors conclude that, when inserted properly, this trocar is safe for use in morbidly obese patients undergoing laparoscopic gastric-bypass procedures.