A. Voitk et S. Rizoli, Blunt Hasson trocar injury: Long intra-abdominal trocar and lean patient -A dangerous combination, J LAP ADV A, 11(4), 2001, pp. 259-262
Citations number
16
Categorie Soggetti
Surgery
Journal title
JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES-PART A
Injury at the time of trocar placement with the Hasson approach is rare. Th
e cone of the Hasson cannula is wedged into the skin for an air seal, and,
using fascial sutures, fastened under tension to flanges of the cannula. Th
e shorter the fascial securing suture, the greater the tension and the more
secure the air seal. Flanges for securing the fascial suture were attached
to the external cannula in early Hasson cannula models. With these, much o
f the trocar needs to be intra-abdominal in order to shorten the suture. Fo
r lean patients, with very little distance between the anterior and posteri
or abdominal walls, the force required to fasten the sutures to the flanges
may allow an intra-abdominal trocar to damage intervening organs. Later ve
rsions of the cannula had the flanges attached to the cone, allowing for sh
ort suture without need for intra-abdominal cannula. These models avoid the
possibility of such injury. An unusually lean patient underwent laparoscop
ic cholecystectomy using an older Hasson cannula with flanges for the fasci
al securing suture attached to the cannula. Postoperative changes in vital
signs and hemoglobin led to a diagnosis of intra-abdominal bleeding, and la
parotomy revealed a transsected branch of the middle colic artery. Earlier
Hasson cannulas, where the flanges are attached to the cannula, should be r
eplaced with those with flanges attached to the cone.