Prospective randomized comparison of cutting and dilating disposable trocars for access during laparoscopic renal surgery.
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.
Venkatesh
Ramakrishna
R
Washington University School of Medicine, Division of Urology, St. Louis, Missouri 63110, USA. venkateshr@wudosis.wustl.edu
Sundaram
Chandru P
CP
Figenshau
Robert S
RS
Yan
Yan
Y
Andriole
Gerald L
GL
Clayman
Ralph V
RV
Landman
Jaime
J
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