Trocars

Trocars are available in a wide array of types and sizes, and in disposable and nondisposable varieties (Figure 2.8). Although individual surgeons may have preferences, our current preference is the practical combination of disposable and reusable trocars. Recent disposable trocars no longer have sharp conical or pyramidal tips, but slim blunt tips that require less force to penetrate through the abdominal wall. Because they minimize the abdominal wall (muscles) trauma at insertion, good stabilization can be anticipated during instrument with-

Trocar Laparoscopic Surgery

Figure 2.8. Different types of abdominal wall cannulas/trocars: A Endopath™ bladeless (Ethicon, Sommerville, NJ), B VersaStep™ (USSC, Norwalk, CT), and C EndoTIP™ (Storz, Tuttlingen, Germany).

Figure 2.8. Different types of abdominal wall cannulas/trocars: A Endopath™ bladeless (Ethicon, Sommerville, NJ), B VersaStep™ (USSC, Norwalk, CT), and C EndoTIP™ (Storz, Tuttlingen, Germany).

Different Trocar
Figure 2.9. Hasson cannula (Ethicon, Sommerville, NJ) and Balloon cannula (Origin; USSC, Norwalk, CT).

drawal and manipulation, when an appropriate length of incision is made. As for reusable trocars, we no longer use classical bladed-trocars as well. Our current choice is screw-in type metal trocars (EndoTIP™; Karl-Storz, Tuttlingen, Germany), which provide safe and easy insertion with good stabilization. In general, reusable trocars are more cost-effective compared with disposable ones; however, care must be taken to keep the stylettes or screws sharp, because they tend to dull with repeated use.

An "open" technique (insertion of the initial cannula through a small laparotomy) is routinely used by some surgeons, because they believe that it is safer than "blind" Veress needle puncture. Even Veress needle users occasionally use the open technique when intraabdominal adhesions are strongly suspected. Because the open method may potentially cause continuous gas leaks around the cannula, a specially designed Hasson-type cannula with peritoneal/fascial sutures is used (Figure 2.9). Trocars with inner balloon/outer disc stabilizers may provide better fixation onto the abdominal wall, making gas leaks and sheath slippage minimal during procedures.

For the initial introduction of the cannula, the optical access trocar (e.g., Optiview™ of Ethicon, Visiport™ of USSC) is another choice. It is a blunt trocar, which is guided through the abdominal wall with the camera (laparoscope) inside and controlled by the monitor. Some surgeons prefer this device, advocating that it can combine the advantages of a safe (open method) and a fast (closed method) penetration of the abdominal cavity.14

In our opinion, an optimal trocar design for advanced laparoscopic surgery should meet the following conditions:

• Good fixation to the abdominal wall, both superficially and deeply, so that the cannula remains in place during instrument exchange and manipulation.

• The cannula should form an airtight seal with the abdominal wall.

• A universal seal mechanism should be present in the instrument channel, so that instruments with different diameters can be inserted and withdrawn without friction and without a converter or an adapter.

Hand-Access Devices for Colorectal Hand-Assisted Laparoscopic Surgery

Hand-assisted laparoscopic surgery (HALS) is a new development that allows a surgeon to easily insert a hand into the abdominal cavity during laparoscopic surgery. A specially designed hand-access device is necessary to maintain pneumoperitoneum and facilitate the hand insertion/withdrawal and manipulation during HALS. Because the intracorporeal manipulation is more extensive and multiquadrant in colorectal procedures compared with other general surgical procedures, the device should be durable and flexible so that a wide range of movement of the surgeon's hand causes neither gas leakage nor device malfunction. Among several commercially available products, our current preference is the GelPort™ (Applied Medical, Rancho Santa Margarita, CA; Figure 2.10).15 The precise role of hand-access devices will be described in the specific procedure chapters.

Hand Assisted Laparoscopic
Figure 2.10. Gelport™ hand-access device (Applied Medical, Rancho Santa Margarita, CA).
A
Names Laparoscopic Graspers
Figure 2.11. Various types of laparoscopic graspers: A Maryland dissector, B Bowel grasper, and C Babcock type grasper.
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Responses

  • mantissa
    What are the different types of trocars?
    7 years ago
  • miska
    How to insert laparoscopic trocars?
    7 years ago
  • Diamanda
    What is a laproscopic trocar and sheath?
    6 years ago
  • stefan
    How to insert your laparoscopic trocars properly?
    6 years ago
  • Prudenzia
    What are types of hasson cannulas?
    5 years ago
  • Ermenegilda
    How to insert subumbilical trocar?
    5 years ago
  • erlinda bluford
    What is important to surgeons using reusable trocars?
    2 years ago

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