Reducing trocar movement in operative laparoscopy through use of a fixator

摘要

Study Objective: To evaluate trocar stability using a fixation device to control trocar insertion depth and in particular to provide greater stability during laparoscopic procedures, and to evaluate the effects of using a fixator to control mobility of trocars. Design: Non-blinded prospective study (Canadian Task Force classification II-2). Setting: University hospital department of gynecology, obstetrics, and gynecological oncology. Patients: Forty-three patients scheduled to undergo gynecologic laparoscopic intervention with planned operative time >10minutes. Interventions: In all procedures, 5-mm working trocars bearing a plain (smooth) sleeve were used. The fixator device, consecutively either on the left or right side, was attached to 1 of 2 side trocars before insertion. In 18 patients, an unsutured fixator was used (FX-US subgroup). In the remaining 25 patients, the device was sutured to the skin via specially designed suturing ports (FX-S subgroup). The position of both trocars in the groups with a fixator (FX group) and without a fixator (NFX group) in the abdominal wall was evaluated at the start of the procedure and every 10 minutes intraoperatively. Measurements and Main Results: In the FX group, there was significantly decreased trocar movement compared with theNFX group (mean [SD] 0.02 [0.6] cm vs 0.84 [4.4] cm). In addition, in the NFX group, the trocar tended to slip into the abdomen during the operation, whereas in the FX group, trocars tended to slip out. Of 43 ports, 11 (25.6%) had to be either reinserted or readjusted at some point during the operation. In 2 procedures, reinsertion of the trocar at exactly the same location was impossible. In the FX-US subgroup, there was 1 incidence of trocar dislocation, whereas there were no dislocations in the FX-S subgroup. The difference in the effect between the 2 study arms, fixator unsutured and fixator sutured, was expected to produce only a small benefit in the sutured fixator arm; however, the benefit was greater than anticipated. Conclusion: Use of a fixator significantly reduces plain (smooth) sleeve trocar movement and prohibits complete dislocation or slippage of the port, and suturing the device to the skin further minimizes trocar movement. Trocar stabilization via a fixation device may lead to shorter operative time and reduce problems associated with trocar slippage or dislocation.