An Easy and Safe way to Open Direct Trocar Access Method in Laparoscopy: The Patrick’s Window.
Background
Access to achieve capno-peritoneum during laparoscopy could be Closed (Veress) or Open (Hanson’s or Direct trocar) method. The beginner is face with challenges of avoiding bowel or visceral injury during entry. An experience laparoscopy surgeon also tries to use a safe and faster approach which sometimes may be challenging.
Aim
To propose and elucidate an easy and safe guide in direct trocar access method during laparoscopy. The Patrick’s Window.
Method
The supra- or infra-umbilical crease was incised and carried down to a thin layer of tissue deficient of subcutaneous tissue at the cicatrix of the umbilicus. This created a well circumscribed window (The Patrick’s window). A curved number one or three artery forceps was passed cephalad and opened with jaw facing downwards. The 10mm trocar was then passed in between opened jaw of the forceps, with mild abdominal wall traction. The video telescope was used to confirm successful access by visualizing visceral or bowel structures.
Results
In 65 laparoscopy surgery performed with this method, No bowel or visceral injury was seen or observed during entry or primary port placement. The average access time was 2 minutes 15 seconds.
Conclusion
The Patrick’s window is very easy, safe and fast access guide to direct trocar access method during laparoscopy. This will be a very good way for a beginner in laparoscopy surgery.
Keywords: Direct trocar access method, laparoscopy, Patrick’s window.
