title: A novel procedure for introducing a large gauze into the corporeal cavity by using a slim trocar (the Tornado gauze procedure).
abstract: BACKGROUND
  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).
  
  
  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.
authors.affiliation: Department of Surgery, Nishijin Hospital, 1035 Mizomae-cho, Kamigyo-ku, Kyoto, Japan. yuen-n@koto.kpu-m.ac.jp
authors.forename: Yuen
authors.initials: Y
authors.lastname: Nakase
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Takagi
authors.forename: Kanehisa
authors.initials: K
authors.lastname: Fukumoto
authors.forename: Takuya
authors.initials: T
authors.lastname: Miyagaki
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation / Q000379:methods; D004867:Equipment Design; D016558:Hemostasis, Endoscopic / Q000295:instrumentation*; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods*; D011028:Pneumoperitoneum, Artificial; D015503:Surgical Sponges