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Fixity of ports to the abdominal wall during laparoscopic surgery: a randomized comparison of cutting versus blunt trocars

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Abstract

Background

Dislodgement of ports from the abdominal wall is a common problem during laparoscopic surgery. The aim of this study was to evaluate port stability using either cutting or blunt-tipped trocars.

Methods

Patients undergoing laparoscopic surgery were randomized to have the secondary ports inserted using either cutting or blunt-tipped trocars. The fixity of ports to the abdominal wall was evaluated at the start and completion of surgery by measuring the total traction force required to displace the ports. Similarly, the friction forces required to displace instruments within the ports were measured.

Results

Thirty patients were randomized into two groups (15 patients in each group), and a total of 114 ports (cutting, n = 51; blunt, n = 63) were evaluated. The groups were comparable in age, gender, body mass index, and operating time. The total traction forces needed to displace the 5-mm and 10-mm ports were significantly lower when cutting trocars were used at both the beginning (2.6 vs. 11.8 N, p < 0.001, and 6.3 vs. 15.5 N, p = 0.014, respectively) and completion of surgery (1.3 vs. 6.7 N, p < 0.001, and 1.1 vs. 12.0 N, p = 0.001, respectively). The declines in the total traction forces from the start to the completion of surgery were significant for the 5-mm and 10-mm cutting-trocar ports (p = 0.031 and p = 0.043, respectively) but not for the blunt-trocar ports (p = 0.088 and p = 0.152, respectively). While no significant differences between the instruments’ friction forces and the traction forces of the cutting-trocar ports were observed, the former were significantly lower than the traction force needed to displace the blunt-trocar ports. This explains the significantly greater frequency of spontaneous port dislodgements when cutting ports were employed (25.5% vs. 1.6%, p < 0.001). Port-site bleeding was encountered only in patients (n = 2, 13%) where cutting trocars were used.

Conclusions

Port fixity to the abdominal wall during laparoscopic surgery declines with time. The insertion of ports using a blunt-tipped trocar is associated with significantly greater stability and fixity of the port to the abdominal wall. The use of blunt-tipped trocars is recommended for routine practice in laparoscopic surgery.

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References

  1. Ammori BJ, Morais JC (1996) A simple method of closure of laparoscopic trocar site. J R Coll Surg Edinb 41: 120–121

    PubMed  CAS  Google Scholar 

  2. Bemelman WA, Dunker MS, Busch OR, Den Boer KT, de Wit LT, Gouma DJ (2000) Efficacy of establishment of pneumoperitoneum with the Veress needle, Hasson trocar, and modified blunt trocar (TrocDoc): a randomized study. J Laparoendosc Adv Surg Tech A 10: 325–330

    Article  PubMed  CAS  Google Scholar 

  3. Bhattacharya S, Tate JJ, Davidson BR, Hobbs KE (1994) Abdominal wall haematoma complicating laparoscopic cholecystectomy. HPB Surg 7: 291–296

    PubMed  CAS  Google Scholar 

  4. Corson SL, Chandler JG, Way LW (2001) Survey of laparoscopic entry injuries provoking litigation. J Am Assoc Gynecol Laparosc 8: 341–347

    Article  PubMed  CAS  Google Scholar 

  5. El-Dhuwaib Y, Hamade AM, Issa ME, Balbisi BM, Abid G, Ammori BJ (2004) An “all 5-mm ports” selective approach to laparoscopic cholecystectomy, appendectomy, and anti-reflux surgery. Surg Laparosc Endosc Percutan Tech 14: 141–144

    Article  PubMed  Google Scholar 

  6. Orvieto M, Breyer B, Sokoloff M, Shalhav AH (2004) Aortic injury during initial blunt trocar laparoscopic access for renal surgery. J Urol 171: 349–350

    Article  PubMed  Google Scholar 

  7. Hamade AM, Butt I, Balbisi B, Ross G, Al-Hourani S, Al-Bahrani AZ, Ammori BJ (2006) Closed blunt-trocar 5 mm-port for primary cannulation in laparoscopic surgery: A safe technique. Surg Laparosc Endosc Percutan Tech 16: 156–160

    Article  PubMed  Google Scholar 

  8. Patel SC, Jumba GF, Akmal S (2003) Laparoscopic appendicectomy at the Aga Khan Hospital, Nairobi. East Afr Med J 80: 447–451

    PubMed  CAS  Google Scholar 

  9. Picod G, Jambon AC, Vinatier D, Dubois P (2005) What can the operator actually feel when performing a laparoscopy? Surg Endosc 19: 95–100

    Article  PubMed  CAS  Google Scholar 

  10. Shalhav AL, Barret E, Lifshitz DA, Stevens LH, Gardner TA, Lingeman JE (2002) Transperitoneal laparoscopic renal surgery using blunt 12-mm trocar without fascial closure. J Endourol 16: 43–46

    Article  PubMed  Google Scholar 

  11. Voitk A, Rizoli S (2001) Blunt hasson trocar injury: long intra-abdominal trocar and lean patient—a dangerous combination. J Laparoendosc Adv Surg Tech A 11: 259–262

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK

    A. M. Hamade, M. E. Issa & B. J. Ammori

  2. Department of Medical Engineering, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK

    K. R. Haylett

Authors
  1. A. M. Hamade
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  2. M. E. Issa
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  3. K. R. Haylett
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  4. B. J. Ammori
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Corresponding author

Correspondence to B. J. Ammori.

Additional information

Presented at the 13th International Congress of the European Association of Endoscopic Surgery, Venice, Italy, 1–4 June 2005

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Hamade, A.M., Issa, M.E., Haylett, K.R. et al. Fixity of ports to the abdominal wall during laparoscopic surgery: a randomized comparison of cutting versus blunt trocars. Surg Endosc 21, 965–969 (2007). https://doi.org/10.1007/s00464-006-9142-3

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  • DOI: https://doi.org/10.1007/s00464-006-9142-3

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