Of note, for decades, the placement of the Veress needle and the initial trocar have been "blind" procedures. Particularly anxiety provoking is the placement of the initial bladed trocar as this maneuver is fraught with the potential, albeit rare, for vascular injury and death. Advances in trocar technology have now provided the surgeon with nonbladed, dilating trocars which reduce the risk of vascular injury by nearly 8 fold and the risk of port site herniation by 10 fold. Furthermore, even 12 mm nonbladed placed ports can be removed, in most cases, without the need to close the fascia thereby decreasing operative time and expense. Indeed, in our operating room the only fascial closure still done is for midline umbilical ports > 10 mm and even that is not done in other centers. Furthermore with the optical bladeless trocars, one can now "look" one's way into the peritoneal cavity thereby eliminating the "blind" placement of the initial trocar following establishment of a Veress needle pneumoperitoneum.

European Urology 50: 958-968, November 2006

Written by Ralph V. Clayman, MD, a Contributing Editor with UroToday.

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