title: Prospective randomized comparison of cutting and dilating disposable trocars for access during laparoscopic renal surgery.
abstract: OBJECTIVE
  Traditional trocar tip design for laparoscopic access incorporates cutting blades to penetrate the body wall. More recently, trocars applying tissue dilation have been used that create a smaller defect, seldom requiring fascial wound closure. Four 12-mm commercially available single-use trocar designs were evaluated for postoperative pain.
  
  
  METHODS
  The 4-trocar types included 2 cutting (single or pyramidal bladed) and 2 dilating trocars (radially or axially dilating) type. Fifty-six patients undergoing transperitoneal laparoscopic renal surgery were randomized and blinded to one of the 4 trocar types. In each case, trocars were placed in a standard "diamond" configuration: three 12-mm study trocars and a lateral 5-mm trocar that served as a reference point for normalizing patients' pain scores. Postoperative pain based on a visual analog scale and complications were assessed.
  
  
  RESULTS
  No statistically significant difference existed in pain scores between different trocar types or trocar sites at 3-hour, 24-hour, and 1-week postoperative assessment time points. Eight (4.8%) minor complications occurred: bleeding in 7 (4.2%) and 1 (0.6%) wound infection. The radially dilating trocar had more device malfunction (P<0.05) than did the others.
  
  
  CONCLUSIONS
  All 4 disposable trocars, muscle cutting or dilating type, were safe and yielded similar postoperative pain scores with or without the fascial wound closure after renal laparoscopy.
authors.affiliation: Washington University School of Medicine, Division of Urology, St. Louis, Missouri 63110, USA. venkateshr@wudosis.wustl.edu
authors.forename: Ramakrishna
authors.initials: R
authors.lastname: Venkatesh
authors.forename: Chandru P
authors.initials: CP
authors.lastname: Sundaram
authors.forename: Robert S
authors.initials: RS
authors.lastname: Figenshau
authors.forename: Yan
authors.initials: Y
authors.lastname: Yan
authors.forename: Gerald L
authors.initials: GL
authors.lastname: Andriole
authors.forename: Ralph V
authors.initials: RV
authors.lastname: Clayman
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004209:Disposable Equipment; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000601:surgery*; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome