Fixity of ports to the abdominal wall during laparoscopic surgery: a randomized comparison of cutting versus blunt trocar
Source:Surgical Endoscopy, 2007
|
Author:youwai
|
Published time: 2018-05-06
|
1314 Views
|
Share:
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. 11.8N, 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
