Which approach is recommended for trocar insertion in thin patients to minimize complications?

• A. Elevate the abdomen and place Veress needle away from midline near the costal margin; consider open approach or Visiport for direct visualization
• B. Follow standard insertion without modification
• C. Schedule laparoscopy after preoperative imaging
• D. Use open approach only

Answer: (A)

In lean or thin patients, the abdominal wall is closely apposed to intraperitoneal organs, so entry carries a higher risk of blind injury. The safest approach is to modify trocar entry to create space and visualize or control the entry. Elevating the abdomen helps separate the viscera from the wall, reducing the chance of hitting underlying organs as you introduce instruments. Positioning the Veress needle away from the midline near the costal margin further distances the entry from critical structures and harnesses the abdominal wall’s thickness where it’s safer. If there’s any doubt about a blind entry, using a direct visualization method such as a Visiport or opting for an open (Hasson) technique provides entry under direct sight, which markedly lowers the risk of complications. Standard insertion without modification overlooks these safety adjustments, scheduling imaging doesn’t address the entry risks, and using only an open approach is unnecessarily restrictive in many cases.