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]
Bibliography
- Best Laparoscopic Surgical Instruments – Smail [Internet]. Smailmedical.com. 2021 [cited 11 November 2021]. Available from: https://www.smailmedical.com/laparoscopic-surgical-instruments.html
- Nolan M. Précis de Médicine Pastorale. Augustinianum. 1962;2(1):221-222.
- Krishnakumar S, Tambe P. Entry complications in laparoscopic surgery. Journal of Gynecological Endoscopy and Surgery. 2009;1(1):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/
- 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/
- Redirecting [Internet]. Doi.org. 2021 [cited 11 November 2021]. Available from: https://doi.org/10.1016/j.ijsu.2014.05.047