ArticleJSLS : Journal of the Society of Laparoendoscopic Surgeons
Optimal Initial Trocar Placement for Morbidly Obese Patients.
Article in JSLS : Journal of the Society of Laparoendoscopic Surgeons. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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4 citing papers in PubMed, 19 citations in OpenAlex.
- Role of Anatomical Structure Recognition in Enhancing the Safety and Efficiency of Initial Optical Trocar Insertion in Patients with Obesity Who Underwent Laparoscopic Sleeve Gastrectomy.Obesity surgery · 2025Article
- A Simple Way to Estimate a Difficult Sleeve Gastrectomy Prior to Operating.Obesity surgery · 2024Article
- Factors that make Bariatric Surgery Technically Challenging: A Survey of 370 Bariatric Surgeons.World journal of surgery · 2021Article
- Staging laparoscopy and Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) for peritoneal metastasis: safe access to the abdomen.Pleura and peritoneum · 2019Article
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1 author at 1 institution in 1 country.
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Abstract
BACKGROUND AND
objectivesRates of morbid obesity are skyrocketing worldwide. Not only bariatric surgeons, but also general surgeons are often operating on morbidly obese patients. Many general surgeons still use the same anatomic landmarks for patients with body mass index (BMI) over 35 mg/kg
methodThe xiphoid process is the only landmark referenced. From the xiphoid process, the surgeon puts 2 fists together and places the first trocar inferiorly 2 cm lateral to the midline in either direction. The umbilicus is not used as a landmark. This placement is 15-18 cm inferior to the xiphoid process, but allows adequate visualization for any foregut case. An optical trocar is used.
resultsIn over 1400 bariatric cases, the initial trocar was safely placed with this technique. Most of these cases were performed with the method, but some had one modification: the first trocar was placed in the midclavicular line in the subcostal area if there were previous midline scars. In no cases was an extra-long, or bariatric, trocar used.
conclusionsLaparoscopic access in morbidly obese patients does not have to be difficult. Using an optical trocar off the midline 15-18 cm below the xiphoid process will provide reliable, safe access in the morbidly obese patient, with excellent visualization of the target anatomy.
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