Access Device 1: Multiple Trocars Method

Abstract

In this chapter, the Multiple Trocars Method will be explained using an Optical View Method.

A 2- to 2.5-cm vertical skin incision is made just above the umbilicus and the fascial defect is grasped with Kocher’s clamp. After creation of the pneumoperitoneum by Veress needle, a 5 or 12 mm trocar suitable for optical viewing in which a direct vision camera is inserted via the fascial defect for optical viewing. Next, two trocars are inserted twisting without additional fascia incision. By using ports with different length, mutual interference of the port heads is easily avoidable. Since all of the devices can be inserted without additional fascia incision, as mentioned above, this method can minimize the injury of the insertion site. This method can be economical, because all of the devices used are reusable except the first optical viewing trocar.

For cholecystectomy for the non-inflamed gallbladder or small organs removal like appendectomy, an incision at the umbilicus can be very small. In this case, the procedure can be done by inserting two trocars from the umbilicus or using another thin forceps. Approximately 1- to 1.5-cm vertical incision is made from the center of the umbilicus to the cranial or caudal side, a concave of the navel is preserved. A camera trocar is inserted as described above. Only one working trocar is inserted from the umbilicus and a trocar for a thin forceps is inserted elsewhere. This particular procedure may be better cosmetically compared to the TANKO procedure.