Laparoscopy, known as a minimally invasive surgical technique, allows surgeons to perform complex surgeries through small incisions. The key to the success of laparoscopic surgery lies in using standard and high-quality instruments. Trocars are tools designed for safe and precise access to the abdominal cavity. By following this article, you will become familiar with the laparoscopic trocars, their advantages, and the usage method.

What is a Laparoscopic Trocar?

Trocars are vital components of laparoscopic surgery that enable surgeons to perform surgery with smaller incisions, less trauma, and faster recovery times compared to open surgery.

Essentially, trocars are used to create access points, known as ports, in the abdominal wall. These ports facilitate the insertion of specialized tools such as the laparoscope and various surgical instruments into the abdominal cavity. Thus, without the need for large incisions, various instruments can enter the body, hence why laparoscopic surgery is referred to as minimally invasive surgery.

Laparoscopic trocars come in various sizes and designs to meet the needs of surgeons.

Components of a laparoscopic Trocar

A laparoscopic trocar typically consists of the following components:

• Cannula: A metal or plastic shaft inserted into the abdominal cavity to create a path for instrument entry and to seal the abdominal opening to prevent gas leakage into the patient’s body. Essentially, there is a valve at the top of the cannula that allows instruments to enter and exit during surgery without the escape of carbon dioxide gas.
• Obturator: The inner shaft of the trocar, which is removed after the cannula is in place to allow instruments to be inserted into the trocar. This component aids in piercing the abdominal wall and guiding the cannula.
• Trocar Handle: Used by the surgeon for control and stability during insertion.

Types of Trocars

• Blade Trocars: These trocars have cutting edges and are used to create incisions when inserting the trocar into the body.
• Blunt Trocars: These trocars do not have cutting edges and are used in cases where small incisions are desired.

Different Sizes of Trocars

Laparoscopic trocars are manufactured in various sizes to accommodate different patient needs and the entry of various instruments. Common trocar sizes include:

• 3 millimeters
• 5 millimeters (the most commonly used for general laparoscopy)
• 10 millimeters
• 12 millimeters
• 15 millimeters

Applications of Laparoscopic Trocars

Various types of laparoscopic trocars are used in a wide range of minimally invasive procedures, including but not limited to:

• Cholecystectomy
• Appendectomy
• Hernia repair
• Diagnostic laparoscopy
• Thoracic surgeries
• Gynecological surgeries
• Urological surgeries

Preparing for Laparoscopic Surgery

Before surgery, the surgical team should:

• Review the patient’s medical history, including previous surgeries or any drug allergies.
• Advise the patient to adhere to preoperative instructions to reduce the risk of aspiration during anesthesia.
• Typically, patients are instructed not to eat or drink anything for a specific period before surgery.
• Perform necessary preoperative tests such as blood tests, electrocardiograms (ECG), or imaging depending on the patient’s health status and surgical conditions.
• Mark the surgical site to prevent surgery in the wrong location before the procedure begins.
• Ensure that all laparoscopic instruments and equipment, including laparoscopes, trocars, and monitors, are functional and ready for use.
• Position the patient on the operating table appropriately. The patient’s positioning is crucial to ensure access to the surgical site and patient comfort.
• Prepare the surgical site by creating a sterile environment. This involves using antiseptic solutions, sterile drapes, gloves, gowns, and other sterile instruments.
• The anesthesiologist should evaluate the patient and ensure that the patient is ready for anesthesia. Once anesthesia is administered, the surgical procedure officially begins.

Selection of Trocar Placement Site

The number and placement of trocars vary depending on the type and purpose of the surgery and are usually determined before the procedure. Common sites for trocar placement include:

• The umbilical region: Used as the primary access point in many procedures.
• Left upper quadrant (LUQ): Often used in surgeries related to the spleen or stomach.
• Right upper quadrant (RUQ): Commonly used in surgeries related to the liver or gallbladder.
• Subumbilical: Used in gynecological and pelvic surgeries.

Placement of trocars

The correct and precise placement of trocars is crucial for ensuring patient safety and the success of the surgical procedure. Below are the step-by-step guidelines for placing trocars:

1-Trocar Entry

The surgeon follows the steps below to puncture the abdominal wall and create a suitable access port:

• The skin at the designated site is incised.
• With controlled force, the trocar tip is inserted through the incision until it punctures the abdominal wall.
• Once the abdominal wall is punctured, the cannula is inserted to create an appropriate port.

2- Insufflation of Gas into the Abdominal Cavity

To create sufficient space in the abdominal cavity, carbon dioxide gas (CO₂) is introduced through the cannula. This gas distends the abdomen and allows better visualization and access to surgical instruments.

3- Entry of Surgical Instruments

The laparoscope is inserted through one of the ports to provide visual guidance for the surgeon. Trocars or additional ports may be inserted to accommodate other instruments.

4- Surgical Procedures

The surgeon performs the surgical procedure using the laparoscope and other instruments.

5- Removal of Instruments and Completion of Surgery

 Upon completion of the steps, instruments and gas are removed from the abdomen. Trocars are removed, and the abdominal wall is inspected for any bleeding or damage. Incisions are usually closed with sutures or adhesive tapes.

Aftercare Following Laparoscopic Surgery

After completing laparoscopic surgery, the patient should follow a set of steps to ensure their health and overall surgical success. Some of these actions include:

• Adhering to all postoperative instructions, including medication schedules and wound care provided by the surgeon.
• Using prescribed pain relievers for post-operative pain relief. If pain is not adequately controlled, inform your doctor.
• Contact your surgeon if you notice any signs of infection at the trocar insertion site, such as redness, swelling, increased pain, or discharge.
• Consuming food and fluids according to your surgeon’s instructions.
• Maintaining adequate hydration to aid in the recovery process.
• Following your surgeon’s recommendations regarding physical activity. Initially, you may be advised to limit strenuous activities and avoid lifting heavy objects. Getting enough rest to aid in recovery.
• Monitoring your bowel function. Laparoscopic surgery can sometimes affect gastrointestinal function.
• Keeping the incision site clean and dry. Avoid soaking the incisions in water until cleared by the surgeon.
• Engaging in short walks as recommended by your surgeon to prevent blood clots and improve blood circulation.
• Have follow-up appointments with your doctor and address any concerns or questions you may have.

Benefits of Laparoscopic Trocars

• Reduced postoperative pain and wound size
• Faster recovery and shorter hospital stays
• Lower risk of infection
• Ensuring optimal and sufficient visualization for the surgeon

How Long Does Recovery Take After Laparoscopic Surgery?

Remember that the recovery time varies depending on the surgical method and the patient’s condition. It is essential to follow your surgeon’s guidance during the recovery period. Proper postoperative care plays a significant role in ensuring your health.

Summary

Laparoscopic trocars are essential tools in modern surgical methods that enable minimally invasive surgery with minimal trauma and rapid recovery. Proper trocar placement, along with adherence to sterile principles and careful patient monitoring, is crucial for the success of this surgical approach. Surgeons and healthcare providers must have sufficient expertise in using laparoscopic trocars to ensure that patients receive surgical interventions with the highest quality.