Fixity of ports to the abdominal wall during laparoscopic surgery: a randomized comparison of cutting versus blunt trocars

Abstract

Port fixity to the abdominal wall during laparoscopic surgery declines with time. The insertion of ports using a blunt-tipped trocar is associated with significantly greater stability and fixity of the port to the abdominal wall. The use of blunt-tipped trocars is recommended for routine practice in laparoscopic surgery.

Initial Laparoscopic Access Using an Optical Trocar Without Pneumoperitoneum Is Safe and Effective in the Morbidly Obese

“…The use of the bladeless blunttip trocar separates muscle and fascia rather than cutting it, which may help prevent trocar site hernia and abdominal wall vascular injury. [21][22][23] In our study, no patient had a trocar-site hernia identified during the follow-up period, and no patient developed bleeding at a DTI port site. Berch et al 13 also reported the same using the optical access trocar without a previous pneumoperitoneum in 327 obese patients.…”

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

“…During laparoscopic procedures, the port site may become loose and dislodge the trocar from the abdominal wall, causing gas leakage, hypothermia, and frequent trocar displacement. The problem is more common with cutting‐edge trocars . When the abdominal cavity is entered using an open technique, an inadvertently wide fascial incision may cause problems from the beginning of procedure.…”

A multidisciplinary evidence-based guideline for minimally invasive surgery: part 2—laparoscopic port instruments, trocar site closure, and electrosurgical techniques

“…A study revealed that blunt-tipped conical port instruments have a significantly greater fixity to the abdominal wall compared to cutting port instruments, resulting in significantly lower numbers of spontaneous port dislodgement during surgery [14]. Accordingly, the use of blunt-tipped instruments could reduce antecedent gas leak and loss of pneumoperitoneum and the need for port replacement with its associated increase in risk of trauma to the abdominal wall.…”

“…In four, REA instruments were compared with standard port instruments for primary port entry [10][11][12][13]. Two RCTs compared cutting and blunt port instruments for primary and secondary port entry [14,15], and in two RCTs, the REA instrument was compared to a conventional instrument with cutting tip for secondary port entry [16,17]. Trials that analyzed major complications with low incidences had too small sample sizes to identify any differences [10,12,[15][16][17].…”

“…In short, the EBGD process includes the following steps: (1) problem analysis; (2) explicit formulation of the questions that the guideline is addressing (key questions); (3) defining eligibility criteria for evidence to be considered; (4) conducting a comprehensive search for evidence (search strategies are appended, see Appendix); (5) evaluating study quality; (6) summarizing the evidence and drawing scientific conclusions; (7) balancing the benefits and downsides of the alternative management strategies, discussing values and preferences (other considerations); (8) formulating recommendations based on evidence and consensus clinical opinion; (9) discussion about the draft guideline within working group; (10) setting up a final draft guideline; (11) external review by members of the participating scientific associations; (12) revision and finalization of the guideline; and finally, (13) authorization and (14) dissemination of the multidisciplinary guideline by the participating scientific professional associations.…”