Description:
<jats:title>ABSTRACT</jats:title><jats:p><jats:bold>Background and objective</jats:bold> Different techniques have been previously described for the induction of pneumoperitoneum to start laparoscopy. This is the first description of a technique of semi‐open direct trocar insertion in which the peritoneum is first opened and a trocar is then directly inserted without insufflation.</jats:p><jats:p><jats:bold>Patients and methods</jats:bold> The technique was tested in 184 (89.3%) out of 206 patients who underwent laparoscopy at our institution over a 1‐year period. In 22 patients, closed entry through Palmer's upper quadrant with a Veress needle was used. An incision was made at the deepest point of the umbilical scar down to the peritoneal membrane which was entered to a depth of 1–2 mm. Direct trocar insertion was then performed.</jats:p><jats:p><jats:bold>Results</jats:bold> Direct trocar insertion was successful in 171 (92.9%) patients at the first attempt, and in 183 out of 184 (99.4%) by the third attempt. The approach was changed to upper quadrant entry in only one patient. The technique was faster and easier than upper quadrant entry. No major complication was observed.</jats:p><jats:p><jats:bold>Conclusions</jats:bold> Semi‐open direct trocar insertion can be performed safely in the starting phase of laparoscopy.</jats:p>