The barrier-free trocar technique in three laparoscopic standard procedures

Abstract

BACKGROUND:Numerous technical and surgical innovations took place in laparoscopic surgery in the recent past. It is debatable whether single-access surgery or natural orifice surgery (NOS) will establish for several standard procedures. Most of the NOS-procedures are controversial and single-access surgery still has to prove its equality in controlled trials. In the intention to reduce the ingress incisons and to facilitate instrumentation, we decided to test the barrier-free AirSeal®-trocar in clinical practice.MATERIALS AND METHODS:Laparoscopically we performed a cholecystectomy, gastric wedge-resection and a fundoplication using the barrier-free AirSeal® 12-mm-trocar. This trocar works without any mechanical barrier so that via this trocar the use of two instruments is possible.RESULTS:All three operations were successful.CONCLUSION:Laparoscopic standard procedures are feasible using this barrier-free trocar without a higher degree of difficulty. Because of the facilitated instrumentation, it is possible to work more efficiently and to maintain the focus on the surgical field.

The Lister AirSeal® port closure technique – Initial patient outcomes

“…The AirSeal® (ConMed, NY, USA) port has been widely adopted in robotically assisted laparoscopic prostatectomy as well as other laparoscopic and robotically assisted procedures due to its ability to provide valve-free access and to maintain stable pneumoperitoneal pressures and smoke evacuation. 1 For robotically assisted laparoscopic prostatectomy and cystoprostatectomy we have been using the 12mm version, as this instrument allows for great utility for the bedside assistant. However, the larger size of the port site has a potential increased risk of port site hernia.…”

Granular analysis reveals smart insufflation to be operationally more efficient and financially net positive compared to traditional insufflation for laparoscopic surgery

“…Traditional insufflation (TI) techniques involve the manual adjustment of the pressure of the pneumoperitoneum during the procedure, while smart insufflation (SI) techniques involve the use of low pressure and valve free access 6 . SI techniques are increasingly being utilized as they provide an immediate response time to even small changes in intra-abdominal pressure [6][7][8][9][10][11][12][13][14][15][16] .…”

“…Although considerable literature exists to substantiate the benefits of SI regarding surgeon preference, procedural ease and improved patient outcomes, there remains a paucity in the literature on the granular financial impact of these devices 7,9,10,[14][15][16][17] . This is an important question to address as these SI devices not only require a larger capital outlay than TI devices, but also increased disposable costs per case.…”