FAQ On Trocar Use And Operating Room Coordination: Enhancing Efficiency Through Medical Team Collaboration

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The use of trocar needles concerns not only the surgeon's technique but also the cooperation between scrub/ circulating nurses, instrument preparation, and emergency handling. Frequently asked clinical questions are compiled below:

Q1: How to determine the skin incision size?

In principle, the incision diameter ≈ the outer diameter of the cannula. For a 5 mm trocar, make a 5 mm transverse incision (along skin lines); for a 10 mm trocar, 10–12 mm; for a 12 mm trocar, slightly larger by 2 mm to facilitate insertion. Too small an incision creates excessive resistance, unconsciously prompting the surgeon to apply more force and increasing injury risk; too large causes air leaks, requiring sutures to secure the cannula.

Q2: Can you directly blind-puncture a trocar without establishing pneumoperitoneum?

Not recommended as routine (except for the open Hasson method). Without pneumoperitoneum, the anterior abdominal wall is close to the posterior peritoneum and great vessels, making blind puncture extremely prone to injury. Exceptions are made only in emergencies (e.g., tension pneumothorax requiring immediate decompression with a specialized large trocar). Routine laparoscopy must first establish pneumoperitoneum with a Veress needle or use the Hasson open method.

Q3: What if the trocar suddenly leaks air or dislodges during surgery?

Mild subcutaneous gas escape-confirm whether the cannula is fully screwed in place or secure it with towel clamps/sutures; severe dislodgement-pause the operation, re-insert the same size or slightly smaller trocar under laparoscopic monitoring, and check the original port for bleeding. If the valve leaks, replace with a spare trocar.

Q4: Precautions for obese/emaciated patients?

Obese → choose extended (≥120 mm) trocars, insert vertically, lift the abdominal wall adequately, temporarily set insufflation pressure at 14–15 mmHg to help separate the abdominal wall layers; Emaciated → pay extra attention to lifting the abdomen to prevent excessive depth, strictly execute the depth-limiting finger protection method, and initially set pneumoperitoneum pressure at 8–10 mmHg, slowly increasing.

Q5: Nurse's preoperative preparation checklist?

① Verify that the trocar specifications (diameter × length) match the surgical plan; ② Confirm that disposable product packaging is intact and not expired / reusable products are sterilized and within expiry; ③ Prepare reducers, backup trocars, silk sutures for fixation, insufflation tubing, and connectors; ④ When passing the trocar during surgery, announce the model and assist in connecting the insufflation tubing; ⑤ Postoperative collection should follow reprocessing or medical waste分流.

Q6: Pediatric precautions?

Select pediatric-specific short types (30–60 mm) of 3 mm or 5 mm trocars, make smaller incisions, lower insufflation pressure (8–10 mmHg), and strictly limit depth throughout to prevent penetrating too deeply and injuring posterior structures.

Good doctor-nurse cooperation-accurately passing matching specifications, timely securing to prevent dislodgement, having identical replacements ready, and standardizing post-use handling-can optimize the efficiency and safety of trocar needle use to the highest level, representing an important aspect of lean management in modern operating rooms.