The Sakarya Technique for Safer Laparoscopic Access

Abstract

Background: Abdominal access is the crucial step for laparoscopic surgery, and there is no consensus for the ideal technique for initial trocar placement. We aim to introduce our new technique used for safe initial entry to create pneumoperitoneum in transabdominal laparoscopic surgery and compare it with the Veress needle technique. Methods: We retrospectively reviewed 317 consecutive patients who underwent urological laparoscopic surgery between January 2016 and January 2025. For the initial trocar insertion, 98 patients with the Veress needle technique and 182 patients with our Sakarya technique were included in the study. All procedures were performed by a single experienced surgeon. Patients\" characteristics, time from skin incision to camera entry, gas leakage, and complications were recorded. Results: The median age was 58 years (interquartile range [IQR]: 45-66), the median body mass index (BMI) was 27.68 (25.06-29.96), and 128 (40.4%) of patients were female. In our Sakarya technique, no major vascular complications were observed, but renal cyst rupture occurred in one patient, and the gas leakage rate was 5.5%. No significant difference was found in complications and gas leakage rates between the Sakarya technique and the Veress needle technique (P > .05). The time from skin incision to camera entry was 27 seconds (IQR: 23-32) with the Sakarya technique, significantly less than the 105 seconds (IQR: 96-124) with the Veress needle technique (P < .001). Conclusions: The Sakarya technique is an easy, safe, and fast method for initial trocar insertion in laparoscopic surgery.