Complications Related to the Initial Trocar Insertion of 3 Different Techniques: A Systematic Review and Meta-analysis

Nishimura, Mai; Matsumoto, Sachiko; Ohara, Yasuhiro; Minowa, Kaoru; Tsunematsu, Risa; Takimoto, Kanako; Imai, Kazuaki; Tsuzuki, Yoko; Ota, Hajime; Nakajima, Ayako; Fukushi, Yukiharu; Wada, Shinichiro; Fujino, Takafumi; Ito, Yoichi M.

doi:10.1016/j.jmig.2018.06.023

Cited by 14 publications

(13 citation statements)

References 31 publications

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“…Some systematic review compared different laparoscopic entry techniques. 10,15,16 One of them evaluated 57 randomized controlled trials, including 25 techniques (as direct vision entry, open entry Evidence and Veress needle entry techniques) and concluded that there was insufficient evidence to support the use of one laparoscopic entry technique over another. 10 Another Japanese systematic review highlighted 17 studies and also did not reported any difference when comparing major complications (major vessel injury, gastrointestinal injury, and solid organ injury) 16 .…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Insertion of Various Shaped Trocars in a Porcine Model

Moreno

Pereira

Anna

et al. 2019

JSLS

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Background and Objective: The number of laparoscopic procedures increases annually with an estimated 3% of complications, one third of them linked to Verres' needle or trocar insertion. The safety and efficacy of ports insertion during laparoscopic surgery may be related the technique but also to trocar design. This study aims to compare physical parameters of abdominal wall penetration for 5 different trocars. Methods: Eleven pigs were studied. Five different commercially available trocars were randomically inserted at the midline. Real-time video recording of the insertions was achieved to measure the excursion of the abdominal wall and the time and distance the cutting surface of the bladed trocars was exposed inside the abdominal cavity. An especially designed hand sensor was developed and placed between the trocar and the hand of the surgeon to record force required for abdominal wall perforation. Results: Greater deformations and forces occurred in nonbladed as compared to bladed trocars, and in conical trocars as compared to pyramidal pointed ones, except for peritoneum perforation. Greater distance and time of blade exposure occurred in pyramidal laminae as compared to conical. Conclusion: The bladed trocars have lower forces and deformations in their introduction, and should be those that cause less injury and are more suitable for first entry. Conical and pyramidal trocars with the same blade size showed similar force, deformation, time, and distance of exposed blade.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Insertion of Various Shaped Trocars in a Porcine Model

Moreno

Pereira

Anna

et al. 2019

JSLS

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“…Iatrogenic aortic injury is generally repaired by simple direct suture or by endovascular technique by stent grafting. 6,7 However, in this patient, the defect size was large and was not suitable for direct repair since it involved loss of more than 2/3rd of circumference, a woven interposition graft was used. We did not have the facilities for endovascular repair in our setup.…”

Section: Discussionmentioning

confidence: 95%

“…5 A recent meta-analysis concluded that DTI causes fewer major vascular injuries when compared with other two techniques; however, the difference was statistically not significant. 6 In this case, DTI was employed; however, it was with an optical trocar which theoretically should reduce further the incidence of major vascular injury. Lack of experience of surgeon, use of too much force, U-shaped vigorous motion technique, thin linea alba, abnormal angulation, and inappropriate length of trocar are all the risk factors for injuring a major vessel while inserting a primary trocar.…”

Section: Discussionmentioning

confidence: 99%

Optical Trocar Causing Aortic Injury: A Potentially Fatal Complication of Minimal Access Surgery

Rashid¹,

Ahmed²,

Ahmed³

et al. 2020

J Coll Physicians Surg Pak

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Trocar injury to abdominal aorta is uncommon and even rare with optical trocars. Such injury, resulting from umbilical trocar insertion, is potentially fatal. It often causes on-table death due to torrential life-threatening haemorrhage and unavailability of expert vascular help. We present a rare case of an injury to infra-renal abdominal aorta, caused by optical trocar insertion for bariatric surgery. Immediate recognition of the injury, deployment of life-saving manoeuvres, timely resuscitation, followed by definitive repair of aorta by vascular surgeon was life-saving for this patient. The recovery phase was uneventful and patient had no residual clinical problems during follow-up.

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“…15 However, in 2019, a large meta-analysis concluded that although major complications were extremely rare with any method of primary trocar entry, in terms of minor complications, DTI was the safest method. 16 The technique of DTI as described in the methodology is followed in all cases in order to standardize the technique and minimize any variations that might increase the likelihood of injury. This becomes more relevant in any training institute where the risks of complications are inherently increased.…”

Section: Discussionmentioning

confidence: 99%

Safety of Direct Trocar Entry in Laparoscopy in a Structured Fellowship Programme

Trehan

Padiyath

Kaur

et al. 2019

Int. J. Hum. Health Sci.

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Introduction:The best method of primary trocar insertion in laparoscopy remains controversial. There are advocates for both initial Veress needle insertion as well as direct trocar insertion.Aim of the study: This study was carried out to find out the complication rate of direct trocar insertion as a method of laparoscopic entry and find out the learning curve of trainees in a structured fellowship programme.Methodology: Retrospective analysis was done over period of 5 years with a sample size of 2053 subjects.Results: 2053 laparoscopic surgeries were examined. Overall complication rate was 0.38%; subjects with previous abdominal surgery were found to have higher complication rate as compared to ones with no history of prior surgery. [0.46% and 0.35% respectively]. All trainees gained reasonable degree of confidence within 6 months.Conclusion: Direct trocar insertion is a safe method of laparoscopic entry, which can be taught to trainees with no prior laparoscopic experience, without an increase in entry complications.International Journal of Human and Health Sciences Vol. 04 No. 01 January’20 Page : 51-54

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Complications Related to the Initial Trocar Insertion of 3 Different Techniques: A Systematic Review and Meta-analysis

Cited by 14 publications

References 31 publications

Laparoscopic Insertion of Various Shaped Trocars in a Porcine Model

Laparoscopic Insertion of Various Shaped Trocars in a Porcine Model

Optical Trocar Causing Aortic Injury: A Potentially Fatal Complication of Minimal Access Surgery

Safety of Direct Trocar Entry in Laparoscopy in a Structured Fellowship Programme

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