Background <p>The global prevalence of obesity has risen significantly, thereby resulting in a consequential increase in the use of bariatric surgical procedures. Optical trocars are extensively utilized for identifying laparoscopic access in patients with morbid obesity. However, their efficacy and safety are dependent on the surgeon’s capability to accurately identify anatomical structures during insertion. The current study investigated the influence of anatomical structure recognition and insertion time on successful optical trocar insertion, which can offer insights that are applicable to various surgical specialties.</p> Methods <p>This retrospective study was conducted on 143 patients who underwent laparoscopic sleeve gastrectomy. Data on demographic characteristics, comorbidities, anatomical structure recognition, and trocar insertion time were collected. To evaluate the associations between these factors, a statistical analysis using the univariate and multivariate models was performed.</p> Results <p>The recognition of anatomical structures such as the rectus abdominis and peritoneum during the procedure was significantly related to shorter insertion times (<i>p</i> &lt; 0.01). Multivariate analysis revealed that an accurate identification of these structures independently contributed to an efficient trocar placement. The risk of complications increased in cases where the peritoneum could not be clearly identified. However, there were no cases of major vascular or organ injuries, and all complications were managed with conservative treatment.</p> Conclusions <p>Successful trocar insertion in patients with morbid obesity is dependent on the precise recognition of anatomical structures, particularly the rectus abdominis and peritoneum. This approach enhances both procedural safety and efficiency, and the findings may have broader applicability to laparoscopic techniques.</p>