Access techniques for endoscopic surgery - types of trocars, ports and cannulae - an overview

Trocar systems with different transperitoneal access techniques are indispe nsable for laparoscopic surgery. The development of laparoscopic surgery ha s led to the establishment of two different techniques of access to the per itoneal cavity: first, there is the closed establishment of a pneumoperiton eum by direct trocar or by means of a Veress needle puncture of the abdomin al cavity; this first 'blind' step of laparoscopy can be facilitated by opt ical control of the penetration process. The second technique is the open t rocar application, first described by Hasson. Generally, trocar systems dif fer with respect to their reusability and there are also differences in the perforator techniques used. Particularly in single-use trocars, 'safety' p erforators are applied, in which a shield protects the cutting device. Perf orators can also be blunt, or vary in their cutting characteristics, with d ilatation trocars at the extreme end of the scale, The risk of potential le sions to the abdominal wall and intraperitoneal organs is crucial for the e valuation of any given trocar system. When considering both cost aspects an d technical details, the reusable steel trocar with a cone-shaped perforato r currently appears to be the best compromise.