Laparoscopic surgery complications associated with trocar tip design: Review of literature and own results

In the last 10 years, there has not been an abdominal surgical procedure th at has not been performed by laparoscopic means. The enthusiasm of surgeons active in this field often neglects problems, especially with basic instru ments which are important vehicles for the laparoscopic technique. The purp ose of this study was to focus on trocar-related problems with special resp ect to the tip design. On the basis of a prospective study of laparoscopic transperitoneal hernia repair (TAPP) and laparoscopic Nissen fundoplication , we evaluated our data concerning trocar-related complications at the abdo minal wall. We compared two groups of patients treated in a nonrandomized d esign with either sharp cutting single-use trocars or cone-shaped non-cutti ng reuseable trocars. The evaluation of our own data showed an incisional h ernia in 1.83% of patients treated with a sharp trocar tip, a complication which could be significantly lowered, to 0.17%, with a conic tip design. Si milar results could be seen with trocar-related bleeding events at the inse rtion site in the abdominal wall. In most publications, trocar design and r elated complications are unmentioned. Our data demonstrate a reasonable ben efit for a conic tip design, which enables atraumatic insertion through the abdominal wall. The reuseable steel version furthermore holds a considerab le cost-saving potential.