New Trends in Trocar Use: Operational Evolution Under Visual Safety Trocars, Single-Port, And Robot Assistance

https://www.cookmedical.com/products/ir_dtn_webds/

Traditional blind trocar puncture is being profoundly transformed by new technologies-how to integrate visualization and intelligence into the "usage" phase to enhance safety is a current high-heat topic in the medical device industry.

Usage Essentials of Optical Visual Trocars:​ Insert a 5 mm or 10 mm laparoscope into the central channel of the trocar obturator and lock it, then turn on the cold light source. The surgeon rotates and advances the trocar while observing through the eyepiece-successively seeing the dermis, subcutaneous fat, rectus abdominis aponeurosis (white dense reflection), and peritoneum (semi-transparent membrane fluctuating with respiration). When the peritoneum is lifted and suddenly dips and disappears, and the view opens up to reveal yellow reflections (omentum) or pink intestines in the abdominal cavity, entry is confirmed. Stop, remove the endoscopic lock, then withdraw the obturator. The entire process under direct vision avoids accidental injury to adherent bowels or major vessels from blind puncture, especially suitable for patients with BMI >30, history of laparotomy, or repeat laparoscopic liver/gynecological surgeries. Studies show optical trocars can reduce first-port related complications by over 60%.

Usage of Safety Shield Trocars:​ Spring-loaded design-before puncture, the sharp tip is exposed; the instant resistance disappears upon penetrating the peritoneum, the built-in spring deploys a blunt shield to cover the sharp tip, limiting insertion depth. The surgeon only needs to rotate and advance normally without extra "hand withdrawal"; the shield automatically intervenes to reduce misoperation injury. Note: Safety trocars are not suitable for extremely thickened abdominal walls (the shield may deploy prematurely before full penetration), so surgeons should combine tactile feedback for judgment.

Single-Incision Laparoscopy (SILS/LESS) and Multi-Channel Port Use:​ Single-incision transumbilical surgery no longer uses multiple independent trocars but employs integrated multi-channel ports (typically containing 3 overlapping cannulas-one for the camera, two for operating instruments). The port is inserted through a 2–3 cm umbilical incision, fixed with an inflatable balloon or外翻 skirt edge. Crossed instrument operation requires special articulating instruments. This raises new requirements for trocar use skills regarding triangular layout and instrument avoidance.

Differences in Trocar Use During Robot-Assisted Surgery:​ Da Vinci or domestic surgical robot systems require trocars with metal reinforcement rings (to prevent robotic arm rotation from wearing through plastic cannulas) and port placement in an inverted trapezoid/arc to ensure robotic arms don't interfere (typically port spacing >8 cm). The first trocar is still inserted by hand; the rest are placed under camera monitoring. After the robotic arms are docked, trocars are no longer frequently inserted or withdrawn. Confirm that the seal valve is compatible with the robotic instrument diameter during docking.

Future intelligent trocars integrating pressure sensing, puncture resistance feedback, and built-in smoke evacuation channels will further revolutionize the "usage" experience-but regardless of how technology iterates, "perceiving the breakthrough, prioritizing direct vision, and controlling depth" remain the eternal safety foundation.