Laparoscopic Surgery Complications Associated with Trocar Tip Design: Review of Literature and Own Results

Abstract

In the last 10 years, there has not been an abdominal surgical procedure that has not been performed by laparoscopic means. The enthusiasm of surgeons active in this field often neglects problems, especially with basic instruments which are important vehicles for the laparoscopic technique. The purpose of this study was to focus on trocar-related problems with special respect to the tip design. On the basis of a prospective study of laparoscopic transperitoneal hernia repair (TAPP) and laparoscopic Nissen fundoplication, we evaluated our data concerning trocar-related complications at the abdominal wall. We compared two groups of patients treated in a nonrandomized design with either sharp cutting single-use trocars or cone-shaped non-cutting reuseable trocars. The evaluation of our own data showed an incisional hernia in 1.83% of patients treated with a sharp trocar tip, a complication which could be significantly lowered, to 0.17%, with a conic tip design. Similar results could be seen with trocar-related bleeding events at the insertion site in the abdominal wall. In most publications, trocar design and related complications are unmentioned. Our data demonstrate a reasonable benefit for a conic tip design, which enables atraumatic insertion through the abdominal wall. The reuseable steel version furthermore holds a considerable cost-saving potential.

Incisional Hernias

“…There is a tenfold increase in the incidence of extraumbilical hernias, if a 12-mm port is used. Other factors incriminated include long duration of surgery and multiple insertions, large quantities of fluid left in the peritoneal cavity, inadequate evacuation of pneumoperitoneum and unrelaxed abdominal wall at the end of the procedure, and increased abdominal pressure at the end of surgery [75, 76]. …”

Port Site Hernia : A Rare Complication of Laparoscopy

“…Many authors have recommended the deflation of pneumo-peritonium prior to port removal so that omentum and intestines are not drawn into the fascial defect. Other techniques to prevent herniation include fascial closure using fascial closure device, suture carrier and Deschamps needle [5,6]. Some authors have also reported a lower incidence of hernias with the use a paramedian incision and non bladed trocars which have a conical tip [6].…”

Visible Angle on Magnetic Resonance Imaging Can Be Considered Indicator of Postoperative Outcome in Retropubic Radical Prostatectomy

“…Port site hernias may have significant morbidity as the smaller size of the defect can lead to entrapment and strangulation of bowel and omentum. The risk of a trocar site hernia is 0.8-1.2% [72]. The rate of hernia occurrence is higher with 12 mm trocars (as opposed to 10 mm or 5 mm) [73] and with cutting trocars (as opposed to blunt or radially expanding) [74].…”