NHS Hospital 2

The Problem

Portsmouth Hospitals NHS Trust Queen Alexandra Hospital wanted to consider additional options when it came to certain products that are used in the treatment of patients. The trust was looking for alternative options and the ability to make savings where possible. Furthermore, the trust also wants to make sure that it could source these products from one provider as opposed to multiple suppliers.

The aim is to replace the incumbent trocar, monopolar scissor, suction irrigation and retrieval bag range. These would be replaced with the Genmed alternatives. The trocars were initially trialled by Mr Carter at Portsmouth Spire and he claimed that he liked the trocars and would like to trial them at Portsmouth’s Queen Alexandra Hospital.

The aim of the trial, which involved the Genmed Trocar was to determine if the performance of the Genmed trocars could bring with them additional savings when compared to that of the balloon trocar which is used by some consultants.

While Genmed is not aware of the prices being paid by the trust, the market knowledge of competitor pricing suggests that the savings that are available will be of significant value to the trust.

The Solution

So, in order to offer more product options and cost savings, Genmed were given permission to undertake a comprehensive trial with Trocats, Monopolar Scissors, Suction Irrigation and Retrieval bags.

The trial initially began with the use of the standard threaded trocar range and the aim was to demonstrate where the performance would offer additional savings against the balloon trocar which is used by some consultants.

Genmed does appreciate that the balloon trocar does offer benefits for certain cases and so, it was important that it was made clear that this was understood. The trial started on 14th July and ended on 30th July and throughout the trial, Genmed made sure that all evaluation forms were completed and handed into the relevant individuals. We were also given the weekly laparoscopic cases being undertaken each week. This allowed Genmed to attend all theatres with laparoscopic cases with the aim of gaining permission from the Consultant in theatres to trial the products. Furthermore, it also made it possible to ensure that the necessary products were available to fulfil the cases that day.

The trial involved all staff being made aware of the items that they were using and that they were part of the trial while it was also important to ascertain the preferences of each surgeon. Initially, there was an element of inconsistency on the suction irrigation and this was down to the pressure on the VAX system being set too high. Once this had been identified, the pressure was set correctly and no further issues were experienced.

The Outcome

During the trial, most of the surgeons that used our products agreed that they are acceptable or clinically superior. The majority of evaluations undertaken were for trocars and this is where most of the scores were provided by surgeons. It was also identified that no issues were experienced with the monopolar scissors or the standard retrieval bags. Those surgeons who showed an interest in the Genmed balloon trocars will require additional trials and this will be done on a case-by-case basis with those surgeons.

It was also identified that potential savings could be made by the trust as well as streamline the supply chain. Furthermore, should the products be successfully implemented then further savings opportunities could be explored.

Case Studies

Keep up to date with the latest Genmed case studies.

Complications of Laparoscopic Surgery Vs. Open Surgery In Obese Patients


Laparoscopic surgery is an advancement in conventional surgical techniques. This technique is used for surgeries of the abdominal cavity and pelvis. It is performed for diagnostic as well as therapeutic purposes. 

In laparoscopic surgery, there is no need to open the abdominal cavity. The surgeon inserts a long instrument (laparoscope) through small incisions. The incision length ranges from 8mm to 19 mm. That is why this is also known as keyhole surgery (Peri et al., 2021) (McKay and Blake, 2006) 

Almost every surgical procedure is associated with some complications. These can be classified as intraoperative (during the procedure) and postoperative (after surgical procedure). In this article, we will discuss complications of laparoscopic surgery vs. open surgery in obese patients. 

This minimally invasive surgical technique has far fewer complications as compared to open surgeries. We will compare the complications of both techniques in different surgical procedures. 

1. Laparoscopic vs. open appendectomy in obese patients: 

a. Appendectomy is one of the most commonly performed surgical procedures. A review article published in the international journal of surgery showed the superiority of laparoscopic appendectomy over open appendectomy (Markar et al., 2011). Two thousand three hundred nine appendectomies were compared in this study. 1187 were open appendectomies, and 1187 were laparoscopic. The analysis showed a shorter stay in the hospital after laparoscopic appendectomy. There was no significant difference in wound infection or other postoperative complications. (Markar et al., 2011) 

b. Another meta-analysis was published in the “Journal of minimal access surgery.” This analysis showed a lower wound infection rate and other postoperative complications in laparoscopic surgery than open surgery. All of the operated patients were obese and had a BMI of more than 30. (Ciarrocchi and Amicucci, 2014) 

c. Another study published in SAGES (Society of American Gastrointestinal and Endoscopic Surgeons) journal analyzed complications of appendectomy in 

morbidly obese (BMI more than 40) patients. Out of a total of 1976 patients, laparoscopic appendectomy was performed in 83.1% of patients. This group had a lower rate of pulmonary and surgical wound complications. However, there was no difference in overall mortality. 

2. Laparoscopic vs. open surgery for rectal cancer in obese patients: 

a. A study published in 2016 analyzed clinical data of 268 patients who underwent surgery for rectal cancer. The study showed no significant difference in rates of complications and operative times between the two groups (laparoscopic and open). However, the blood loss was much lower in the laparoscopic group than in the open group. (Matsuzaki et al., 2017). 

b. An article published in 2018 analyzed the effects of increasing BMI on laparoscopic surgery for colorectal cancers. The two objectives of this study were to check the clinical outcome and conversion rate to open surgery, i.e., laparotomy. This article showed that obesity increases the rates of surgical complications such as wound complications and leakage of anastomoses. Recurrence of tumor and mortality rate were not affected by elevated BMI. The conversion rate to open surgery for colon cancer was 4.1 times more in obese patients. (Bell et al., 2018) 

c. Another study was published in “Journal of Laparoendoscopic & Advanced Surgical Techniques” in 2011 to assess the safety of laparoscopic vs. open resection of rectal cancer. The laparoscopic procedure was associated with an earlier time of first discharge, (Matsuzaki et al., 2017, McKay and Blake, 2006, Peri et al., 2021) resumption of bowel movement and food intake. However, there were no significant differences in overall mortality rates (Liang et al., 2011) 

3. Laparoscopic vs. open umbilical hernia repair in obese patients: 

a. A review article published in 2013 in “The American Journal of Surgery.” This study aimed to determine which surgical option had a better outcome. 123 obese (BMI more than 30) patients with umbilical hernias were included in the study. Forty-three patients were operated on by laparoscopic approach, and 80 were operated by open technique. 

No complications were reported during procedures. There was no recurrence of hernia in patients operated by laparoscopic technique. The postoperative wound infection rate was much higher in open umbilical hernia repair. 

b. A systemic review with meta-analysis was published in 2017. A total of 16,549 patients were analyzed. The analysis results showed decreased percentages of wound infection, wound dehiscence and recurrence rates in 

laparoscopic repair compared to open repair. However, the intraoperative time was longer for laparoscopic repair (Bell et al., 2018) 


This article has discussed the outcomes and complications associated with laparoscopic vs. open surgical techniques in obese patients. We chose appendectomy, surgeries for colorectal cancer resection and repair of ventral hernia. Most of the studies suggest that complications associated with the laparoscopic approach are lesser than those associated with the open technique. Only con of the laparoscopic approach was more intraoperative time. Therefore, the laparoscopic approach is more effective and safer than open surgeries in obese patients. 


BELL, S., KONG, J., WALE, R., STAPLES, M., OLIVA, K., WILKINS, S., MC MURRICK, P. & WARRIER, S. 2018. The effect of increasing body mass index on laparoscopic surgery for colon and rectal cancer. Colorectal Disease, 20, 778-788. 

CIARROCCHI, A. & AMICUCCI, G. 2014. Laparoscopic versus open appendectomy in obese patients: A meta-analysis of prospective and retrospective studies. Journal of minimal access surgery, 10, 4. 

LIANG, X., HOU, S., LIU, H., LI, Y., JIANG, B., BAI, W., LI, G., WANG, W., FENG, Y. & GUO, J. 2011. Effectiveness and safety of laparoscopic resection versus open surgery in patients with rectal cancer: a randomized, controlled trial from China. Journal of laparoendoscopic & advanced surgical techniques, 21, 381-385. 

MARKAR, S. R., VENKAT-RAMAN, V., HO, A., KARTHIKESALINGAM, A., KINROSS, J., EVANS, J. & BLOOM, I. 2011. Laparoscopic versus open appendicectomy in obese patients. International Journal of Surgery, 9, 451-455. 

MATSUZAKI, H., ISHIHARA, S., KAWAI, K., MURONO, K., OTANI, K., YASUDA, K., NISHIKAWA, T., TANAKA, T., KIYOMATSU, T. & HATA, K. 2017. Laparoscopic versus open surgery for obese patients with rectal cancer: a retrospective cohort study. Surgery today, 47, 627-635. 

MCKAY, D. & BLAKE, G. 2006. Optimum incision length for port insertion in laparoscopic surgery. The Annals of The Royal College of Surgeons of England, 88, 78-78. 

PERI, A., GREENSTEIN, E., ALON, M., PAI, J. A., DINGJAN, T., REICH-ZELIGER, S., BARNEA, E., BARBOLIN, C., LEVY, R. & ARNEDO-PAC, C. 2021. Combined presentation and immunogenicity analysis reveals a recurrent RAS. Q61K neoantigen in melanoma. The Journal of Clinical Investigation, 131. 

Bladed Trocars Used In Laparoscopic Procedures

Laparoscopy is a contemporary and novel type of minimally invasive surgery that uses microscopic surgical equipment, and it will undoubtedly become more popular in the future. It is a surgical technique that involves making small cuts in the skin to be doing abdomen surgeries. Laparoscopic surgery is a unification of linked disciplines that has established a stable foundation for creating new technologies and methodologies, thanks to the rapid progress of industrial production technologies. Several open procedures there in previous have already been substituted with unrespectable surgeries, thanks to the rising skill of doctors. [1]

Trocars are special instruments that allow access to the vital cavity through the skin. A trocar comprises three parts:

  • An awl that is a plastic or metal point
  • A cannula, essentially a cylindrical tube
  • A cover

Trocars are implanted through to the stomach during laparoscopic surgery. Network adapters, including graspers, scissors, and surgical instruments, can be placed into the trocar's opening. Trocars also allow air or fluids to escape from inside the body. [2]

Today In this article, we will talk about bladed trocars and how they are used in laparoscopic procedures – their risks and associated herniation rate as all of these are closely and inter-related to ache other. So let's get started.

What's the use of trocars in laparoscopic surgery?

Surgical trocars are now usually used on a specific patient and have progressed from the "3" shape, giving them their name to either a flat-bladed "dilating-tip" device or a blade-free product. Because of the procedure utilized to introduce them, the latter version gives extra patient safety.

Trocars are used in laparoscopic surgery to close the skin holes while allowing the operative tools to be inserted and removed. Although trocars are normally safe when inserted through the epidermis into the abdominal wall, problems can result in a tiny percentage of persons.

It is also used to reach and remove fluid deposits in a patient with hydrothorax or ascites.

In today's world, surgical trocars are used to do laparoscopic surgery. They are being used to inject cams and laparoscopic hand equipment, like scissors and mandibles, to execute operations that formerly required a large abdomen incision, resulting in improved patient outcomes. [3]

Complications/risks associated with bladed trocar

A discharging puncture wound of an underneath organ might arise with trocar implantation, leading to a medical problem. A laparoscopic intra-abdominal trocar implant, for example, can cause bowel injury, resulting in peritonitis, or damage to major blood arteries, resulting in bleeding.

Puncture of a large blood vessel (which occurs 0.9 occasions per 1000 operations) and invasion of a critical cavity like the colon, abdomen, or bile duct are the 2 major side effects (which occurs 1.8 times per 1000 procedures). Hemorrhage or cutaneous infection at the trocar implant site is less serious but more common problems. Furthermore, the type of trocar utilized may have an impact on the amount of pain caused during laparoscopy. It's unknown whether certain trocar kinds are less likely to cause complications or pain after surgery. [4]

Associated herniation rate

Visceral injuries caused by the trocar are an uncommon but possibly fatal consequence of laparoscopic access. Abdominal bleeding is more common, which necessitates hemostatic treatments and extends the surgical time.

A Randomized Trials database was searched for randomized studies comparing trocar-related problems with blunt and bladed trocars. The major end measure was the reduction in risk of abdominal trocar site hemorrhage, with internal injuries and overall morbidity as secondary endpoints.

The trocar-associated morbidity rate in the blunt trocar group was 3%, while the bladed trocar group had a trocar-associated morbidity rate of 10%. Abdominal wall hemorrhage occurred in 3% and 9% of the sharp and bladed trocar groups, correspondingly.

The blunt and bladed trocar arms, correspondingly, had a trocar-associated morbidity rate of 0.2 and 0.7 percent, omitting hemorrhaging episodes of the abdominal wall. [5]

Data on the occurrence of major trocar-related effects, such as abdominal or circulatory harm, was insufficient when comparing various trocar kinds. There was only a small amount of evidence for minor trocar-related issues, implying that utilizing radially expanding trocars instead of cutting trocars reduces trocar site hemorrhage.

Another investigation found ten patients with trocar site hernia, with a frequency of 1.6 percent. The average incidence time was 15 months. As a result of the hernia, neither of the patients suffered intestinal blockage or other problems. [6]


  1. Best Laparoscopic Surgical Instruments - Smail [Internet]. Smailmedical.com. 2021 [cited 11 November 2021]. Available from: https://www.smailmedical.com/laparoscopic-surgical-instruments.html
  2. Nolan M. Précis de Médicine Pastorale. Augustinianum. 1962;2(1):221-222.
  3. Krishnakumar S, Tambe P. Entry complications in laparoscopic surgery. Journal of Gynecological Endoscopy and Surgery. 2009;1(1):4.
  4. BLADED SURGICAL TROCAR AND PRODUCT DESIGN CONTRIBUTING TO THE SURGICAL FIELD | Katsan Medical Devices [Internet]. Katsan Medical Devices |. 2021 [cited 11 November 2021]. Available from: https://katsanas.com/en/bladed-surgical-trocar-and-product-design-contributing-to-the-surgical-field/
  5. trials B. Blunt versus bladed trocars in laparoscopic surgery: a systematic review and meta-analysis of randomized trials [Internet]. Ncbi.nlm.nih.gov. 2021 [cited 11 November 2021]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK169364/
  6. Redirecting [Internet]. Doi.org. 2021 [cited 11 November 2021]. Available from: https://doi.org/10.1016/j.ijsu.2014.05.047

Why Choose A Gastric Band Over A Gastric Sleeve

If you're severely overweight or obese, you're probably dealing with more than simply digits on the scale. Getting massively obese can put you at risk for diabetes, cardiovascular disease, fertility problems, stress, and several cancers. Obesity-related dangers can be significantly decreased or even removed with bariatric surgery. Patients who have bariatric surgery may become less reliant on diabetes medicine or no longer require it together.

Bariatric surgery has the potential to change your life. It will not only help you lose weight but also enhance your quality of living. If you're dealing with life-threatening obesity and its implications, it's understandable that you'd consider bariatric surgery – but whom should you go with?

Gastric band surgery and gastric sleeve operation are two of the most frequent bariatric surgeries. Both of these can assist you in losing more than half of your body mass. [1]

In this article, we will talk about why one should choose a gastric band over a gastric sleeve? So let's get started!

A Brief Overview Of Both Procedures:

Gastric band

A major section of the stomach tract is removed during a gastric bypass treatment, allowing only a tiny pouch for food collection. The small intestine coming from the gastric pouch is likewise severed, and the intestine below this point is linked to the new stomach pouches.

As a result, incoming food "skips" the rest of the stomach and goes straight to the shorter small intestine. As a consequence, your body consumes a quarter of the energy it did previously. [2]

Gastric sleeve 

On the other hand, a gastric sleeve surgery does not alter the link between the intestine and the stomach, nor would it leave a piece of the stomach chamber inactive inside the system.

Rather, the surgeon merely eliminates a longitudinal piece of the stomach, providing you with a little, banana-shaped stomach that is otherwise completely operational.

You consume a significantly lower quantity of food here as well, leaving your body with lower-calorie to retain. [2]

Why choose a gastric band over a gastric sleeve?

Both gastric band and gastric sleeve operations are effective, but which one you pick will be determined by several criteria, including:

  • Absorption of nutrients
  • Health problems that come with it
  • Expenses
  • Obesity's severity
  • Now we'll be discussing some of the important factors that will make your choice crystal clear.

Absorption of nutrients:

Although gastric sleeve surgery restricts the quantity of food you can eat, it has no effects on meeting nutritional requirements.

Losing a part of the gastrointestinal tract during gastric bypass surgery makes it difficult to absorb the nutrients, necessitating supplementation.

Health problems that come with it:

Suppose you're seeking to manage obesity-related illnesses like diabetes, high blood pressure, or sleep problems. In that case, you should realize that gastric bypass surgery is probably more efficient than gastric sleeve surgery at doing so, while both procedures can assist.


Even though lap-band surgery, a type of bariatric surgery, is less expensive than either of gastric operations, gastric bypass is typically less expensive than a gastric sleeve.

Obesity's severity:

You should choose gastric bypass over gastric sleeve the more obese you are. This more invasive technique can sometimes result in more significant weight loss. [3]

Benefits of gastric banding

Reversible: Moreover, the gastric band is made to be flexible as well as detachable. If you are unhappy with the band after just a short time, you can have it removed by some other laparoscopic operation.

Decent Results: Although adjustable gastric banding is not as successful as gastric sleeve or gastric bypass, it can help you remove up to 50% of your excessive fat.

Fewer Complications: Gastric banding has fewer problems since the only incisions necessary to implant the laparoscope and put the abdominal line. [4]

Although gastric banding does not need stomach surgery, it does necessitate postoperative dietary requirements and follow-up appointments. Following up with your doctor regularly is critical to your weight reduction progress and general wellbeing. Aside from the risks associated with other weight-loss operations, the band has its own set of consequences, including blockage, band slippage, esophageal dilatation, and inadequate nutrition. It's critical to think about all of your weight-loss surgery alternatives thoroughly.

It's time to look outside the box if you're tired of depending on conventional losing weight strategies to achieve the body you've always desired. You should be aware of the difficulties and select the most appropriate surgical procedure to assist you in reaching your goals.

The Bottom Line:

On average gastric bypass patients lose about 70% of their excess weight. Gastric sleeve patients lose about 60% of their excess weight. Hence the patients who undergo gastric banding get more desired results than the gastric sleeve.


  1. Lap-Band vs. Gastric Sleeve W. Lap-Band vs. Gastric Sleeve, Which Procedure is Right for Me? [Internet]. Cernero Surgery & Aesthetics. 2021 [cited 8 November 2021]. Available from: https://www.cernerosurgery.com/bariatric-surgery/lap-band-vs-gastric-sleeve/
  2. Gastric Sleeve vs. Gastric Bypass: Differences, Pros, Cons [Internet]. Healthline. 2021 [cited 8 November 2021]. Available from: https://www.healthline.com/health/gastric-sleeve-vs-gastric-bypass#recovery
  3. Gastric Bypass vs. Gastric Sleeve: Which One Is Right for You? [Internet]. Olde Del Mar Surgical. 2021 [cited 8 November 2021]. Available from: https://oldedelmarsurgical.com/blog/gastric-bypass-vs-gastric-sleeve/
  4. Bypass G, Balloons G, AspireAssist T, Therapy M, Medication W, Stories S et al. Gastric Banding Vs. Gastric Sleeve: What’s The Difference? – True You Weight Loss [Internet]. True You Weight Loss. 2021 [cited 8 November 2021]. Available from: https://trueyouweightloss.com/blog/gastric-banding-vs-gastric-sleeve-whats-the-difference/
  5. Gastric bands: How it works, surgery, who should have it [Internet]. Medicalnewstoday.com. 2021 [cited 8 November 2021]. Available from: https://www.medicalnewstoday.com/articles/298313

Clinical Product Manager (UK)

Clinical Product Manager

NHS Hospital

The Problem

The NHS trust is always looking to make savings and so, the trust is always looking to make savings in theatres. As it currently stands, the trust uses the Johnson and Johnson Excel range of trocars. However, it has been recognised that this excel range makes up for 15% of trocar usage and s, it is believed that savings could be made if they opt to use the Genmed Trocars.

The problem not only comes in the form of helping to reduce costs but also making sure that surgeons also feel comfortable and confident using Genmed trocars. Of course, the trust wants to continue delivering a high level of care and attention when treating patients, so the trocars have to match or improve on the current quality and value they receive from the Johnson and Johnson Excel range.

The aim is to obtain surgeon approval to replace Excel Trocars with Genmed Trocars and to ensure that patient safety remains a priority.

The Solution

In order to determine whether the Genmed trocars are suitable for use, a trial was put in place. Genmed representatives were not able to be present due to Covid restrictions. A cross-match exercise was undertaken with the trials beginning on the 27th April 2021.

After clinical trial approval was granted, the products used as part of the trial includes the 12mm Optical Trocar with extra cannula and 5 mm Optical Trocar with extra cannula, all of which were to be used as a replacement for the equivalent Excel Trocars.

The evaluations were completed by 11th June 2021 with eight surgeons taking part.

The Outcome

Following the evaluation, it was found that all surgeons had provided feedback with eight of them being happy to proceed with the use of the Genmed products. The results have been taken to Clinical Lead with the aim of requesting sign off and to conclude the process as successful.

This means that the surgeons were happy to make the switch while all comments and recommendations have been addressed accordingly. As a result, the trust had agreed to close off and approve the success of the evaluation with the approval of Genmed Trocars.

Laparoscopic Lead Times

The Current Waiting list for Laparoscopic Surgery

The Current Waiting Lists for Laparoscopic Surgery Post Pandemic

The Covid-19 Pandemic has not just caused problems with deaths from the virus around the world and here in the UK but it has also caused problems when it comes to accessing other forms of treatments.

As hospitals switched their focus to dealing with Covid-19 patients, it meant that wards were full of patients and specialists were being repositioned within hospitals in order to help manage the increasing number of Covid-19 patients. This had a knock-on effect when it came to other procedures such as Laparoscopic Surgery.

Waiting lists were already relatively extensive but the pandemic had caused them to increase considerably which meant that people had to wait longer to receive the treatment that they required. In general, the NHS states that there is a waiting time of around 18 weeks for non-urgent surgical procedures but the pandemic has clearly impacted these times.

Prior to the pandemic, these kinds of procedures would have been managed and carried out under the usual waiting times which would have been a matter of months but now things have changed considerably for patients. Those people who were on the waiting lists prior to the pandemic would have more than likely have had their laparoscopic surgery delayed but during the time of the pandemic, more people would have visited their GP with issues, only to be added to the list themselves. This has meant that not only have waiting times increased as a result of the pandemic but the size of the waiting list has increased and that means even more waiting for patients, especially when urgency is taken into consideration, which could see certain patients have the surgery before others.

As of April this year, it was found that 4.7 million people were still waiting to start treatment. This is the highest figure seen since 2007, when records were started. To break down these figures, there are around 387,885 patients currently waiting more than 12 months to receive treatment, a figure that was just 224,205 in December 2020, proving just how much of an impact the pandemic has had on waiting times [1]. In some instances, some patients are being told that they will have to wait for as long as two years for laparoscopic surgery.

As waiting lists have increased, it has meant that the NHS has had to implement a £160 million initiative as a way of dealing with the growing waiting lists. As it currently stands, operations and other elective activity is already at 80% of what they were prior to the pandemic which is about the 70% threshold as identified in official guidance. Despite this, the NHS still wants to speed up the recovery by adopting new ways of working. The £160 million will be utilised to enhance the capacity for diagnostics while it will also be used to create virtual wards and home assessments as well as at-home antibiotic kits for patients about to undergo surgery. The overall goal is to exceed the same number of tests and treatments that took place prior to the pandemic.

There are signs of improvement as data suggests that services are starting to recover a lot quicker than they did during the first wave. During the first two months of this year, the NHS delivered almost 2 million operations while still dealing with covid patients. So, the UK is making great progress in rolling out the vaccines and that will mean that hospitals will soon be able to make a greater impact on waiting list times