The Tulipan-Bruner trocar for uterine entry during fetal surgery

OBJECTIVE: Our goal was to compare the use of a specially designed trocar f or initial uterine entry with standard entry by electrocautery in creation of a hysterotomy for fetal surgery. STUDY DESIGN: Ten consecutive patients undergoing hysterotomy for intrauter ine repair of myelomeningocele were randomized to initial uterine entry wit h electrocautery or with the Tulipan-Bruner trocar. Timing of initial uteri ne entry with electrocautery began with incision into the uterine serosa an d ended with incision of the chorioamnionic membranes. Timing of initial ut erine entry with the Tulipan-Bruner trocar began with placement of stay sut ures and ended with removal of the central introducer from the peel-away sh eath. Blood loss was estimated by the primary surgeon. All of the participa ting surgeons judged the convenience and ease of each technique. The times required for initial uterine entry were compared with an unpaired t test. S tatistical significance was set at P < .05. RESULTS: The time required for initial uterine entry with electrocautery wa s 231 +/- 63 (mean +/- SD) seconds compared with 146 +/- 51 seconds with th e trocar (P < .05). The total blood loss for all 10 cases was <50 mt, but t he presence of blood in the wound was judged much more inconvenient when el ectrocautery was used. Finally, electrocautery required 2 surgical assistan ts in every case, whereas the trocar was readily placed with only a single assistant. CONCLUSION: The Tulipan-Bruner trocar provides quicker, less traumatic uter ine entry during creation of a hysterotomy, as compared with electrocautery .