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Trocar Injuries in Laparoscopy: Techniques, Tools, and Means for Prevention. A Systematic Review of the Literature

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Abstract

Trocar injuries are a possible cause for severe morbidity and mortality when performing laparoscopic surgery. This systematic review investigates the differences in the incidence of complications depending on the method of entry. A meta-analysis of the medical literature was performed. Search results were limited to clinical trials and the following languages: English, French, German, or Dutch. All results that compared the Veress, Hasson, and direct entry technique or compared sharp, blunt, and radially expanding trocars (RET) were included (n = 19). Studies involving pediatric and pregnant patients were excluded. When comparing the Veress needle to direct trocar insertion (DTI), pooled analysis showed a borderline significant reduction for major complications (p = 0.04) based on five events in 2 RCT’s (n = 978) and a reduction in minor complications (p < 0.001) in favor of DTI. RCT’s comparing the Hasson and Veress techniques showed no significant reduction in major complications (p = 0.17), but the Hasson technique showed significantly less minor complications (p = 0.01) and failed entries (p = 0.002). CO2 leakage was far more common when using the Hasson technique (p < 0.001). Our search method did not reveal any studies comparing the Hasson technique to DTI. When comparing bladed to RET, three studies (n = 408) showed less minor complications when using a RET (p = 0.003) and a qualitative analysis showed a trend toward pain reduction when using RET. This meta-analysis concludes that there are less minor complications and failed attempts when using the Hasson or direct entry technique when compared to the Veress method, but there is limited evidence regarding major complications. RET reduce minor vascular complications when compared to bladed trocars.

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Abbreviations

DT:

Direct trocar

DTI:

Direct trocar insertion

MeSH:

Medical subject heading

RCT:

Randomized controlled trial

RE:

Radially expanding

RET:

Radially expanding trocar

RUQ:

Right upper quadrant

VN:

Veress needle

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Authors and Affiliations

  1. Department of General and Hepatobiliary Surgery and Liver Transplantation, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    Bram Cornette & Frederik Berrevoet

  2. Park de Rode Poort 88, 8200, Sint-Michiels, Belgium

    Bram Cornette

Authors
  1. Bram Cornette
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  2. Frederik Berrevoet
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Correspondence to Bram Cornette.

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Appendix

Appendix

The MEDLINE database was searched for clinical trials using PubMed and the following terms:

Laparoscopy [Mesh] AND “clinical trial” [filter] AND

  1. 1.

    Trocar access (58)

  2. 2.

    Veress (39)

  3. 3.

    Hasson (11)

  4. 4.

    Direct trocar (40)

  5. 5.

    Trocar insertion (58)

  6. 6.

    Entry method (56)

  7. 7.

    Primary port (51)

  8. 8.

    Blunt trocar (6)

  9. 9.

    Bladed trocar (2)

  10. 10.

    Radially expanding (4)

  11. 11.

    Radially expanding trocar (5)

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Cornette, B., Berrevoet, F. Trocar Injuries in Laparoscopy: Techniques, Tools, and Means for Prevention. A Systematic Review of the Literature. World J Surg 40, 2331–2341 (2016). https://doi.org/10.1007/s00268-016-3527-9

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