Laparoscopy without trocars

Abstract

Background: Laparoscopic access devices have consisted of a cannula and sharp trocar. A trocarless endoscopic access cannula was designed to improve safety, eliminate blind entry, save time, and decrease cost. It consists of a threaded hollow cannula with a blunt penetrating distal end.

Methods: After pneumoperitoneum is established with the Veress needle, the laparoscope is inserted into the cannula, and using the blunt tip at the distal end of the thread, the anterior rectus fascia is engaged through a 5–7-mm horizontal fascial incision. Rotation advances the blunt cannula tip past the anterior rectus fascia, muscle, and posterior rectus fascia and through the peritoneum under continuous video control with no axial force.

Results: The trocarless rotational access cannula (TRAC) was used successfully in 135 consecutive unselected patients with no complications.

Conclusions: This access cannula and methods offer many advantages while improving safety and cost.