BACKGROUND: The benefits of laparoscopic surgery are well recognized; but it is not without its associated risks. The most common complication is associated with trocar insertion. The purpose of our study is to identify the safety profile of various trocar/access equipments used in pediatric laparoscopic surgery.
METHODS: In 40 pigs, bladed, non-bladed and needle access systems were evaluated. A pressure profile for each system was determined by measuring the force required to drive the trocar or needle into the peritoneum at zero and 10 mmHg of pressure. In addition, the deformation of the tissue, the length of blade or needle exposed, and the time in which it is exposed was measured using a high-speed digital imaging system.
RESULTS: 14 trocar and needle designs were evaluated. In general, the needle system required the least driving force (mean = 1600 mN, p<0.05) and had the most favorable pressure profile. In contrast, the blunt trocar system required a high driving force (mean = 18000 mN) with a rapid loss of resistance once the trocar enters the abdomen. The bladed retractable and non-retractable system required on the average a driving force of 3200 mN and had similar profile in the lost of resistance. The pressure profiles for the bladed systems were more favorable when inserted under a pneumoperitoneum. With the bladed trocar systems, the blade itself is exposed on the average of 1.2 sec with a length of 3.8 cm. In comparison, the needle system is exposed for 0.2 sec with a length of 1.7 cm.
CONCLUSIONS: In study, we evaluated the safety profiles of various access systems used in pediatric laparoscopic surgeries. By defining the forces required to place the trocars and needles, the pattern of resistance loss and the characteristics of the blade/needle exposure, we are better able to identify risk factors for trocar-related complications. Based upon this study, the insufflation needle system appears to have the safest profile. In addition, inserting a bladed system should be performed with a pneumoperitoneum to reduce the chance of injury.