Differences in Trocar Usage Across Departments: A Comprehensive Analysis Of General Surgery, Gynecology, Urology, And Orthopedics

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Although the basic structure of trocar needles is the same, significant differences exist in puncture site selection, cannula specifications, and puncture techniques across different clinical departments. Understanding these differences is of great value for product promotion and clinical training.

General Surgery-The Most Classic and Widespread Application:​ Laparoscopic cholecystectomy, appendectomy, hernia repair (TAPP/TEP), and gastrointestinal tumor resections all rely on trocars to establish access. Typical configuration: a 10 mm main operating port at the umbilicus (for a 30° laparoscope) + 5 mm operating ports at the right subcostal margin and left lower abdomen; gastrointestinal surgeries often add a 12 mm port for linear cutting staplers. The characteristic of general surgery is that the first port is usually placed via closed technique blind puncture, requiring the trocar obturator to be sufficiently sharp or using disposable products with safety shields to reduce the risk of major vascular injury.

Gynecology-Emphasis on Pelvic Protection and Visual Puncture:​ Myomectomy, ovarian cyst decortication, and total hysterectomy mostly use the lithotomy position. The first puncture is still at the umbilicus or the left upper quadrant (Palmer's point, suitable for patients with a history of lower abdominal surgery to avoid adhesions), with the second and third ports often placed in the bilateral iliac fossae. Because the pelvic space is small and adjacent to the bladder and uterine isthmus, gynecology increasingly prefers optical trocars-inserting a 5 mm endoscope into the hollow channel of the obturator to directly visualize each layer penetrated, especially suitable for patients with suspected adhesions from previous cesarean sections.

Urology-Unique in Transabdominal and Retroperitoneal Dual Approaches:​ Laparoscopic nephrectomy and adrenalectomy can choose transabdominal (similar to general surgery's umbilical first port) or retroperitoneal approach (incision at the mid-axillary line of the waist to insert the trocar and establish the retroperitoneal space, balloon dilated first, then cannulation). Urological trocar use requires caution to avoid accidentally injuring the peritoneum (retroperitoneal approach requires the trocar not to penetrate the peritoneum) and renal vascular injury.

Orthopedics/Arthroscopy-Use of Fine, Short Trocars:​ Knee and shoulder arthroscopy use ultra-fine trocars or specialized cannulas of only 2.7–4 mm in diameter, short in length (30–50 mm). Instead of establishing pneumoperitoneum, saline is injected to distend the joint cavity. Puncture primarily relies on blunt dissection to avoid cutting cartilage edges.

Thoracic Surgery-No Pneumoperitoneum but Sealing Required:​ Thoracoscopic surgery places trocars through intercostal spaces. The thoracic cavity is under negative pressure, so cannulas need excellent sealing valves to prevent pneumothorax. Typically, the 7th–8th intercostal space at the mid-axillary line is chosen as the viewing port, with the 4th–6th intercostal spaces at the anterior/posterior axillary lines as operating ports.

In summary, the clinical use of trocar needles is not "one-size-fits-all"-select extended/standard types based on patient body habitus, visual/blunt-tip/Hasson open methods for high adhesion risk, and place ports according to anatomical characteristics of each department. Product selection and training should match these scenario differences.