Introduction: When a large gauze is needed during a single-incision surgery or reduced port surgery using slim (5-mm) trocars, the operation needs to be interrupted to introduce the gauze via an incision or to change to a large trocar. We describe here a novel procedure for introducing a large gauze into the corporeal cavity by using a slim trocar, called the "Tornado gauze procedure" (TGP). Materials and Methods: Commercially packed Trox ? (Osaki Medical, Nagoya, Japan) gauze (30×150 mm, 4-ply) and a specially ordered precision stainless steel tube (Smart introducer; Kinugawa Factory, Kyoto, Japan) are used for the TGP. The gauze is screwed into the Smart introducer. When the surgeon needs a gauze, a Smart introducer with a gauze is set into the 5-mm trocar; then, the 5-mm grasper is used to push the gauze into the corporeal cavity with small screwing-in movements. The gauze is also gently removed from the corporeal cavity through a 5-mm trocar. Results: This procedure efficiently and safely introduced the gauze for hemostasis, blunt dissection, suction filtering, and organ retraction without interrupting the pneumoperitoneum to introduce the gauze in single-incision laparoscopic cholecystectomy, transabdominal preperitoneal hernia repairs, and appendectomy, with good visualization and adequate working space. The rhythm of surgery remains undisturbed with the use of the TGP, even in a high-risk and high-stress situation. The port's valves were not disabled during surgery, and no procedure-related complications were reported. Conclusions: TGP is expected to be helpful to surgeons and enhance the safety of laparoscopic surgeries involving the use of slim trocars.
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