What is a Laparoscopic Trocar?

Laparoscopy is a modern and common method to perform abdominal surgeries. Creating enough space to access the abdominal cavity is the first step in laparoscopic surgery. For this purpose, a special tool named a trocar can access the organs in the abdominal cavity.

Laparoscopic trocars are available in a wide range of sizes from 3 mm to 15 mm. Asia Jarah Pishro co. provides laparoscopic trocars in 5, 10, and 12 mm sizes to medical centers.

What is laparoscopy?

Laparoscopy is a minimally invasive and low-risk procedure used for intra-abdominal surgeries. This method allows the surgeon to examine the patient’s abdominal cavity with only one or more small incisions without the need to make large incisions, and perform the necessary treatment if needed.

During the laparoscopy, the surgeon uses a laparoscope to examine the organs in the abdominal cavity. The laparoscope is equipment that includes a long and thin cable with a high-resolution camera in front of it and connects to a video device by an end connector that processes the images received from the camera and displays them through a monitor.

A camera connected to the lens and through which it transmits internal images sends the images to the monitor at the same time as the laparoscope moves and provides the doctor with a clear view of the abdominal cavity.

For better vision clarity, light is transmitted through a light source and connected to the lens by a fiber optic cable and from inside it to the surgical cavity.

Many surgeries, such as hernia repair, gastric bypass, gynecological surgeries, and organ removal such as gall bladder, appendix, spleen, etc. are usually performed laparoscopically.

The advantages of laparoscopy compared to open surgery

• Low invasiveness
• Faster recovery
• Less pain
• Fewer recovery time
• Faster return to daily activities (Normal Life)

Definition of the trocar and its role in laparoscopic surgery

The laparoscopic trocar is a specialized medical device used in laparoscopic surgery. In the simplest definition, a trocar is a pen-shaped instrument with a sharp triangular tip used during surgery to create a hole (as an entrance) to access the abdominal cavity.

Other laparoscopic instruments, such as lens, scissors, clamps, etc., will insert into the body’s abdominal cavity through this trocar.

Also, the trocar has a gas port through which carbon dioxide gas transfers to the abdomen and provides enough space to access the organs.

The main usage goal of this product is a safe entry with minimal damage to the fascia and other organs.

New trocars require less force to enter and cause less damage to fascia and other tissues. Whatever less trauma is caused for its insertion, the healing time of the tissue after the operation will be faster and pain will be less.

As mentioned earlier, trocars come in a wide range of sizes from 3 mm to 15 mm. Choosing the right size is by the surgeon, and based on the position and conditions of the surgery.

Laparoscopic trocar types

1.    Cutting Trocar

These types have sharp metal or plastic blades and can cut multiple layers of tissue by applying low pressure and enter the abdomen easily.

2.    Delating Trocar

These trocar types have flat tips that can separate tissues by applying pressure. These opening trocars are non-cutting; they separate the tissues instead of cutting them.

These trocars also need more force to open the tissues and enter the abdominal cavity. This pressure will cause secondary pain for the patient.

Laparoscopic trocars are produced as disposable or multi-use. At first glance, reusable trocars are more affordable, but the costs of maintenance, washing, packaging and continuous sterilization are high for them.

They also increase the risks of contamination remaining in them and transferring to the next patients, which is a very important point.

Specifications

• Provide safe access to abdominal organs with minimal infection and injury
• Providing a sufficient and complete view of the operating site
• Possibility of immediate diagnosis of possible injuries and risks during surgery
• The possibility of immediate repair of injuries with minimal complications
• Suitable dimensions
• The tip is sharp enough to create the desired space
• Sterile
• The Non-reflective inner surface so that the light of the laparoscope does not interfere with the surgeon’s vision.

Different size of AJP trocar

• Trocar 5 mm
• Trocar 10 mm
• Trocar 12 mm

Applications of trocar 5 mm

Trocars 5 mm are among the most common trocars and have many potential uses. They are commonly used in gynecological and urological surgeries.

They may also be used in general surgeries in other parts of the body as well.

Introduction of the AJP trocar size 5

Asia Jarah Pishro co. suggests the AJP trocar size 5 for the convenience of the surgical team and use in laparoscopic surgeries.

With its ergonomic, functional, and safe design, this trocar provides proper access for the surgeon during laparoscopic surgery.

The flow control valve on it provides the possibility to control the entry and exit of laparoscopic gases.

With suitable and one-way valves, it’s possible to enter and exit the laparoscopic instruments into the abdominal cavity without gas leakage during surgery.

The proper design of the trocar tip and the use of a sharp blade make tissue cutting easier and less damage to the fascia.

In this way, these trocars create enough space needed for surgery and provide a complete and proper view for the surgeon.

Basic advantages

• Has a locking system with a key and detachable handle
• Precise control and excellent stabilization due to the locking system design
• Equipped with a sharp blade for comfortable operation and less damage to the fascia
• Blade safety cover
• Convenient trocar handle for ease of use
• Equipped with a flow control valve
• Suitable length
• Transparent cannula for better visibility
• Cannula with a triangular tip for better connection and better instruments movement
• Maintaining the sealed condition during surgery to prevent gas leakage
• The existence of grooves and ridges on the cannula’s body prevents its movement during surgery
• Cost effective

The AJP trocar components

The AJP trocars have three main parts:

1. The first part of a trocar is the cannula.

A cannula is a shaft inserting into the patient’s body to access the abdominal cavity (cannulas can be metal or plastic).

2. The second part (called the Sealing part) is a one-way valve for sealing the trocar.

This valve is located on top of the cannula and guarantees that no air escapes from the abdominal cavity while allowing the passage of surgical equipment.

In other words, this one-way valve doesn’t allow gas leakage but allows entering instruments into the abdomen.

Various valve types exist (such as spring, magnetic, trumpet, silicone, etc.) that offer different characteristics regarding leakage, operation, and location on the cannula.

3. The third part is the blocking part (called the Obturator)

The obturator helps the cannula to make the initial penetration into the abdomen.

Placement method

Laparoscopy begins with general anesthesia or local anesthesia.

Once the patient is anesthetized, trocar placement will perform by making a skin incision around the navel.

These incisions should be large enough to fit the trocar in diameter.

Then, the anterior wall of the abdomen will be lifted by hand or forceps, and the trocar is inserted directly and with rotational motion at a 90-degree angle into the abdominal cavity and goes towards the pelvic cavity.

In the next step, carbon dioxide gas will be injected through the trocar to open the abdominal cavity so that the surgeon can have a clear view of all the internal organs (In some cases, the gas is first injected by the Veress Needle and then the trocar is placed).

After this is done, a laparoscope lens with a camera attached to it inserts into the abdomen so that the surgeon can view the organs on the screen during the surgery.

Then, other surgical instruments such as biopsy instruments, staplers, and other required equipment for cutting and cauterizing tissues and blood vessels will insert through trocars, and the necessary treatments will perform.

After the surgery, all instruments are removed, and the incisions are sutured.

Laparoscopic trocar usage risks

Laparoscopic surgery has led to significant clinical advances in many surgical fields.

However, using a trocar may lead to various complications, such as:

• Vascular damage
• Perforation of abdominal organs such as intestines
• Bleeding at the trocar insertion site
• Skin infection at the trocar insertion site

Many of these cases, such as vascular and visceral damage, are rare; But they may be life-threatening.

Therefore, it’s important to determine how to prevent these complications.