A Randomized Clinical Trial Comparing Two Different Methods of Trocar Placement in Gynecologic Laparoscopy [127]

Abstract

OBJECTIVE: To determine whether the “look” method or the “feel” method of trocar insertion results in placement that is closest to a 90° angle to the patient's anterior abdominal wall. METHODS: This is a prospective, randomized crossover study with patients serving as their own control group. A total of 27 patients aged 24–75 years undergoing gynecologic surgery with either conventional or robotic laparoscopy in an academic hospital setting in New York were included. INTERVENTION: Trocars were placed in the patient's right and left lower quadrants by the same resident using either the “look” or the “feel” method. In the “look” method, the surgeon looked at the video monitor throughout trocar placement. In the “feel” method, the surgeon looked directly at the patient until the fascia was entered, after which the surgeon looked up at the monitor for the rest of the placement. Method and site of placement were randomized within each patient. Once the trocar was inserted to a predetermined mark, the length of the trocar beneath the peritoneum was calculated and used as a surrogate measure for the angle of trocar placement. Local anesthesia was not used. RESULTS: The principal outcome variable was the length of the trocar beneath the peritoneum. Covariates included patient's age and body mass index (BMI, calculated as weight (kg)/[height (m)]2) and the postgraduate year level of the resident who placed both trocars. The mean difference in length of the trocar beneath the peritoneum was 0.18 cm (P=.26) by paired t test. By analysis of covariance, the absolute difference in trocar length between methods was not affected by age, BMI, or postgraduate year level of the resident. The analysis of covariance did show that for both methods, trocar placement was closer to 90° with increasing age above the median age of 45 years (r=−27, P=.02). CONCLUSION: Both “look” and “feel” methods yield similar results in trocar placement; no statistically significant difference was identified.