Trocar In Laparoscopic Surgery Research Articles

Management of abdominal gas leakage from surgical trocars in laparoscopic surgery: a preclinical study

Introduction: There is an ongoing concern about the potential infectious risk due to pneumoperitoneal gas leakage from surgical trocars in laparoscopic surgery. We aimed to visually confirm the presence of leakage from trocars and investigate the changes in the leakage scale according to intra-abdominal pressures and trocar types. Material and methods: We established a porcine pneumoperitoneum model and performed experimental forceps manipulation using 5-mm grasping forceps with 12-mm trocars. The gas leakage, if any, was imaged using a Schlieren optical system, which can visualize minute gas flow invisible to the naked eye. For measuring the scale, we calculated the gas leakage velocity and area using image analysis software. Four types of unused and exhausted disposable trocars were compared. Results: Gas leakage was observed from trocars during forceps insertion and removal. Both the gas leakage velocity and area increased as the intra-abdominal pressure increased. Every type of trocar we handled was associated with gas leakage, and exhausted disposable trocars had the largest scale gas leakage. Conclusions: We confirmed gas leakage from trocars during device traffic. The scale of leakage increased with high intra-abdominal pressure and with the use of exhausted trocars. Current protection against gas leakage may not be sufficient and new surgical safety measures and device development may be needed in the future.

Application of the prone position in myomectomy by transvaginal natural orifice transluminal endoscopic surgery.

IntroductionNatural orifice transluminal endoscopic surgery (NOTES) is a new concept of minimally invasive surgery. It could prevent complications related to the trocar in laparoscopic surgery, and help achieve ideal cosmetic outcomes.AimTo describe the safety and feasibility of the prone position in transvaginal NOTES (V-NOTES) resection of posterior uterine myoma.Material and methodsSeventeen patients were included in the study from February to December 2019. All the patients were diagnosed with solitary posterior uterine myoma and underwent V-NOTES myomectomy in the prone position. We measured the characteristics and the surgical outcomes of these patients, to evaluate the safety and feasibility of the prone position in V-NOTES myomectomy.ResultsThe mean age of the patients was 38.71 ±7.68 years and the mean body mass index was 22 ±2.02 kg/m2. Five patients had a cesarean section once, and 1 patient had a history of two operations (cesarean section and laparoscopic cholecystectomy). The remaining patients had no history of surgery. The mean myoma volume in the ultrasound report was 121.99 ±125.24 cm3. The mean operation time was 107.48 ±34.16 min. The mean hemoglobin decrease 48 h after the operation was 1.37 ±0.66 g/dl. The mean weight of the myoma was 183.88 ±144.29 g. The mean VAS score 12 h and 24 h after surgery was 2 ±0.87 and 1.18 ±0.73, respectively. The mean postoperative hospital stay was 3.18 ±0.39 days. One patient was converted to TU-LESS. No other complications such as massive hemorrhage, infection or injury occurred.ConclusionsThe prone position in V-NOTES myomectomy is safe and feasible. It expands the operative space and reduces the difficulty of surgery. Perhaps it can be used as a standard position for posterior uterine myomectomy by V-NOTES.

A Simple Open Entry Technique for the Initial Trocar in Laparoscopic Surgery

A Simple Open Entry Technique for the Initial Trocar in Laparoscopic Surgery

Design of Magnetic Clutch System for Electromagnetic Control Laparoscopic Surgery Based on Magnetic Anchoring System

Magnetic anchor technique can reduce the number of trocar in laparoscopic surgery. The laparoscopic magnetic anchor system consists of an external anchor magnet and the magnetic clutch system. Electromagnetic control laparoscopic surgery clutch system includes the internal grasper and the operating forceps. In this design, a permanent magnet is set at the tail of the internal grasper, and an electromagnetic device is installed at the head of the operating forceps. The magnetic field direction of the electromagnetic device can be changed by switching the positive pole and the negative pole of the electromagnetic device, so as to control the separation and combination of the operating forceps and the internal grasper. The design of this system is ingenious, easy to manufacture and the operation is simple.

Optical trocar access for initial trocar placement in laparoscopic gastrointestinal surgery: A propensity score-matching analysis.

Optical trocar access is a technique to place the initial trocar in laparoscopic surgery. With optical trocar access, each tissue layer can be visualized before insertion, which can help prevent organ injury, and air leaks at the trocar site can be minimized even in obese patients. The aim of this study was to compare the time needed for trocar insertion using optical trocar access and an open method in patients who underwent laparoscopic gastrointestinal surgery. We reviewed our prospectively collected database and identified 384 patients who underwent laparoscopic gastrointestinal surgery involving initial trocar insertion near the umbilicus by either the optical trocar access or the open method. Before the two methods were compared, propensity score matching was used to adjust for essential variables between the optical trocar access and open groups. Patients categorized in the optical trocar access and open groups were matched one-to-one by propensity score matching, and 137 pairs of patients were generated. The time needed for trocar insertion was significantly shorter in the optical trocar access group than in the open group (36.6 vs 209.8 s, P < 0.01). The multivariable analysis identified an inexperienced surgeon as the only independent risk factor for prolonged time for initial trocar insertion using the optical trocar access. This study indicated that optical trocar access may be recommended for inserting the initial trocar in laparoscopic gastrointestinal surgery.

Tehran's Tie: A simple trick to fix the trocar to the abdominal wall and close the entry site of first trocar in laparoscopic surgery.

Trocar dislodgment can occur frequently during minimally invasive surgery. Closing the entry port at the fascial layer after the end of a long laparoscopic surgery is time-consuming. Here, I introduce Tehran's Tie, a simple trick to overcome these problems. After the first trocar site has been created with the open technique and before the first port is inserted, the fascial wound is grasped with a loop of nylon thread, similar to a transverse matrix suture. Then, the trocar is inserted through the loop into the abdominal cavity. One thread is tied around the trocar to fix it. Another thread is used to tie and close the fascial defect at the end of laparoscopic surgery. Tehran's Tie is a simple trick for managing the first trocar site in laparoscopic surgery. It is a very useful and easy trick for fixing the first trocar to the abdominal wall and for closing the port site at the end of the procedure.

Safe and easy access technique for the first trocar in laparoscopic surgery.

Access-related injuries are still an important consideration and may increase morbidity and mortality. This study aimed to present in detail a safe and easy technique for open insertion of the first trocar. This technique has been used routinely in the vast majority of laparoscopic procedures at first author's department since 1998. The data were collected prospectively and analyzed retrospectively for the 11-year period of January 2005 through December 2015. The primary site of access is the umbilicus, but this technique can be used for all insertion points. A total of 2579 laparoscopic surgical interventions were performed. The abdominal access was established in 2252 patients in open and in 321 cases with blind puncture using a Veress needle. There were three cases (0.9%) of accidental injuries with blind puncture and two cases (0.09%) with open technique. Injuries sustained with open technique injuries were less severe and immediately discernable. None of the patients were converted to open technique. The method can be used easily and rapidly, even in obese patients. It is safer than blind puncture and reduces costs.

A Safe Open Access Technique to Insert the First Trocar in Laparoscopic Surgery

Abstract Objective: Indications for laparoscopic surgery are becoming more numerous across many surgical disciplines. Despite modern developments in techniques and surgical equipment, the search continues for an optimal method of placing the first trocar and establishing a pneumoperitoneum. Subjects and Methods: Since 1998, this technique was used routinely for all laparoscopic procedures, including emergency and trauma cases. We describe a new open-entry technique that is easy to use and minimizes the risk of associated injuries. We enter the abdomen through a vertical incision ~1–1.5 cm long, made anywhere in the abdomen that is expected to be free of adhesions, although the preferred site is the upper edge of the umbilicus. The abdominal wall is elevated with Kocher clamps placed perpendicular to the incision and severed stepwise down to the peritoneum. The fold in the fascia created by the clamps prevents accidental injury to the abdominal organs. Then, the edges of the incision are held together with...

Friction characteristics of trocars in laparoscopic surgery.

This article investigates the friction characteristics of the instrument-trocar interface in laparoscopic surgery for varying linear instrument velocities, trocar seal design and material, and trocar tilt. Furthermore, the effect of applying lubrication at the instrument-trocar seal interface on friction was studied. A friction testing apparatus was designed and built to characterise the resistance force at the instrument-trocar interface as a function of the instrument's linear movement in the 12-mm trocar (at constant velocity) for different design, seal material, and angle of tilt. The resistance force depended on the trocar seal design and material properties, specifically surface roughness, elasticity, hardness, the direction of movement, and the instrument linear velocity, and varied between 0.25 and 8 N. Lubricating the shaft with silicone oil reduced the peak resistance force by 75% for all trocars and eliminated the stick-slip phenomenon evident in non-lubricated cases. The magnitude of fluctuation in resistance force depends on the trocar design and is attributed to stick-slip of the sealing mechanism and is generally higher during retraction in comparison to insertion. Trocars that have an inlet seal made of rubber/polyurethane showed higher resistance forces during retraction. Use of a lubricant significantly reduced frictional effects. Comparisons of the investigated trocars indicate that a low friction port, providing the surgeon with improved haptic feedback, can be designed by improving the tribological properties of the trocar seal interface.

Blunt versus bladed trocars in laparoscopic surgery: a systematic review and meta-analysis of randomized trials

Trocar-associated visceral injuries are rare but potentially fatal complications of laparoscopic access. More commonly, abdominal wall bleeding occurs, which usually requires hemostatic measures and prolongs operative time. Blunt-tipped trocars have been postulated to carry a lower risk of abdominal wall bleeding and intra-abdominal injuries. The aim of the present systematic review and meta-analysis was to comparatively evaluate the relative risks of abdominal wall bleeding, visceral injuries, and overall complications with the use of bladed and blunt-tipped laparoscopic trocars. The databases of Medline, EMBASE, and the Cochrane Central Register of Randomized Trials were searched to identify randomized studies that compared trocar-associated complications with the use of blunt and bladed trocars. Primary outcome measure was the relative risk of abdominal wall trocar site bleeding, and secondary outcome measures included visceral injuries and overall complications. Outcome data were pooled and combined overall effect sizes were calculated using the fixed- or random-effects model. Eight eligible randomized trials were identified; they included 720 patients with a median Jadad score of 4. The incidence of abdominal wall bleeding for the blunt and the bladed trocar group was 3 and 9 %, respectively [odds ratio (OR) 0.42, 95 % confidence interval (CI) 0.21-0.88]. Trocar-associated morbidity rate, excluding bleeding events of the abdominal wall, was documented at 0.2 and 0.7 % of the blunt and the bladed trocar arm, respectively (OR 0.43, 95 % CI 0.06-2.97). The overall trocar-associated morbidity rate was 3 % in the blunt trocar group and 10 % in the bladed trocar group (OR 0.38, 95 % CI 0.19-0.77). Reliable data support a lower relative risk of trocar site bleeding and overall complications with blunt laparoscopic cannulas than bladed trocars. Transition to blunt trocars for secondary cannulation of the abdominal wall is thus strongly recommended. Larger patient populations are required to estimate the relative risk of visceral injuries.

A safe optically guided entry technique using Endopath Xcel Trocars in laparoscopic surgery: A personal series of 821 patients

To demonstrate the technique and clinical safety of primary entry of an optically guided entry approach in laparoscopic surgery. The clinical data from a personal series of 821 consecutive cases of laparoscopic surgery were used. The technique of an optically guided primary entry using an Endopath Xcel trocar was described. There was no bowel, vascular, or visceral complication in this series. This entry approach was also safe in those with high surgical risks, for example, high body mass index, multiple previous abdominal surgeries and previous laparotomy. There was no failed entry, no extraperitoneal insufflation, no wound infection and wound hernia. In this personal series, the findings demonstrated the safety and feasibility of an optically guided entry technique in laparoscopic surgeries.

Safety of open technique for first-trocar placement in laparoscopic surgery: a series of 6,000 cases

The open technique for the placement of the first trocar in laparoscopic surgery has become the preferred method due to the reduced number of complications associated with it. In 2002 we reported our technique, which has been widely accepted at many centers, including all the units of our hospital. We now report on a series of 6,000 cases in which this technique was used. The method is the same as that reported by us previously (Surg Endosc 16:1366-1370, [10]) except for the minor modification of using a Mayo towel clip instead of the Allis forceps for holding the cicatrix pillar, as the pillar tends not to slip out of the former. During closure, Allis forceps is used to lift the divided rectus sheath on each side to take the suture bite and ensure complete secure closure. A total of 6,000 consecutive cases have been performed using this technique in two tertiary care hospitals over the last 11years. A total of 6,000 cases (5,350 females and 650 males) were operated on over an 11-year period. There were no visceral or vascular complications. Four hundred seventy-five patients (7.9%) had had previous abdominal surgery. The supraumbilical route was used in 348 patients and lateral entry in 90 patients. Port-site hernias were seen in 25 cases (0.4%) and wound infections in 56 cases (0.9%). The average time for trocar placement was 2min (range=1-12min) and the average port size was 15mm (range=12-22mm). The average time for port closure at the end of the procedure was 3min (range=1-7min). The technique of open-trocar placement in laparoscopic surgery has now become standardized, with its safety having been well established. Our experience has shown that this technique is safe, effective, reproducible, easy to learn, can be performed quickly, and has excellent results.

Is it safe to reuse disposable laparoscopic trocars? An in vitro testing.

The reuse of disposable laparoscopic instruments carries a risk of transmitting infectious diseases such as hepatitis and HIV. We evaluated the safety of reusing disposable trocars by studying the chances of their harboring infectious viruses after resterilization in an in vitro setting. Disposable laparoscopic trocars were exposed to horse blood contaminated with high or low viral concentrations of herpes simplex virus type 1 (HSV1) and attenuated polio virus type 1 at room temperature for 2 h. HSV1 was chosen as the surrogate for lipid viruses that include hepatitis B and HIV virus; polio virus represented the nonlipid viruses that cause infections in immunocompromised patients and are more resistant to sterilization. The trocars were subsequently cleaned and resterilized by low-temperature steam and formaldehyde at 80 degrees C for 3 h. Viral cultures were then repeated after sterilization. A cytopathic effect (CPE) was demonstrated at both concentrations for HSV1 in all trocars before but not after sterilization. For the polio virus, CPE was evident in 50% of the trocars (two of four) exposed to high viral concentration after sterilization. Disposable trocars are difficult to resterilize and may harbor infectious viruses after their initial use. Therefore, the reuse of disposable trocars in laparoscopic surgery cannot be recommended.

A randomized prospective study of radially expanding trocars in laparoscopic surgery

Trocar injury is one of the most serious and potentially preventable complications of laparoscopic surgery. Use of a blunt rather than a cutting trocar could be expected to lessen the likelihood of this injury. Therefore complications related to laparoscopic port design were studied by comparing conventional cutting trocars with radially expanding (blunt) trocars. A multicenter, prospective, randomized clinical trial was conducted in 250 adult patients undergoing elective laparoscopic procedures at tertiary care centers and community hospitals. The patients were randomly assigned to one of two groups: group C, conventional cutting trocars; or group S, radially expanding trocars. Sixteen surgeons performed 244 elective laparoscopic procedures; six patients were removed from the study. One hundred nineteen patients were assigned to group S and 125 to group C. The groups were similar with regard to age, sex, and type of procedure. The following data were collected: intraoperative complications related to the trocars, abdominal wall bleeding, visceral or vascular injury, other complications, fascial closure, procedure time, trocar site assessment at 4 and 24 hours postoperatively, and visual analog pain scores at 4, 8, 12, and 24 hours postoperatively. Fascial defects from 10 mm or larger trocars in group C were closed; the fascial defects in group S were not closed. The trocar sites were checked for incisional hernias at late follow-up. Mean operating time was not different between the two groups (group S, 92 ± 73 minutes; group C, 100 ± 74 minutes). There were no episodes of intraoperative cannula site bleeding in group S compared with 16 episodes in 13 patients ( P <0.001) in group C. Postoperative wound complications were fewer in group S (13 vs. 23; P <0.05). Although the pain scores were generally lower in group S, the differences were not significant. Only 3% of the patients in group S had fascial defects of 10 mm or greater that had to be closed. Within a follow-up period of 6 to 18 months, there have been no incisional hernias in either group. This study shows that radially expanding trocars are safe and effective, and less likely than conventional trocars to result in intraoperative or postoperative complications. The defects created by the radially expanding trocars do not have to be routinely closed.