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Prospective Assessment of Trocar-Specific Morbidity in Laparoscopy

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Abstract

Background

The purpose of the present study was to challenge the hypothetical advantage of single port laparoscopy (SPL) over conventional laparoscopy by measuring prospectively the morbidity specifically related to conventional trocar sites (TS).

Methods

From November 2010 to December 2011, 300 patients undergoing various laparoscopic procedures were enrolled. Patient, surgery, and trocar characteristics were recorded. We evaluated at three time points (in-hospital and at 1 and 6 months postoperatively) specifically for each TS, pain (Visual Analog Scale), morbidity (infection, hematoma, hernia), and cosmesis (Patient Scar Assessment Score; PSAS). Patients designated their “worst TS,” and a composite endpoint “bad TS” was defined to include any adverse outcome at a TS.

Results

We analyzed 1,074 TS. Follow-up was >90 %. Pain scores of >3/10 at 1 and 6 months postoperatively, were reported by 3 and 1 % of patients at the 5 mm TS and by 9 and 1 % at the larger TS, respectively (5 mm TS vs larger TS; p = 0.001). Pain was significantly lower for TS located in the lower abdomen than for the upper abdomen or the umbilicus (p = 0.001). The overall complication rate was <1 % and significantly lower for the 5 mm TS (hematoma p = 0.046; infection p = 0.0001). No hernia was found. The overall PSAS score was low and significantly lower for the 5 mm TS (p = 0.0001). Significant predictors of “bad TS” were larger TS (p = 0.001), umbilical position (p = 0.0001), emergency surgery (p = 0.0001), accidental trocar exit (p = 0.022), fascia closure (p = 0.006), and specimen extraction site (p = 0.0001).

Conclusions

Specific trocar morbidity is low and almost negligible for 5 mm trocars. The umbilicus appears to be an unfavorable TS.

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Acknowledgments

The authors are grateful to Mrs. Mariotti for administrative help and to Dr. Faouzi for statistical analysis.

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Correspondence to Alessandra Cristaudi or Nicolas Demartines.

Appendices

Appendix 1

Standardized Data Collection Questionnaire.

Appendix 2

Questionnaire: Patient Scar Satisfaction Score (PSAS) [11].

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Cristaudi, A., Matthey-Gié, ML., Demartines, N. et al. Prospective Assessment of Trocar-Specific Morbidity in Laparoscopy. World J Surg 38, 3089–3096 (2014). https://doi.org/10.1007/s00268-014-2683-z

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  • DOI: https://doi.org/10.1007/s00268-014-2683-z

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