Port Layout And Standardized Operation Of Disposable Trocar Sets in Laparoscopic Surgery

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The success of laparoscopic surgery begins with the correct establishment of the first puncture port-and this is precisely when the disposable trocar set demonstrates its value. Whether it is cholecystectomy, appendectomy, gastrointestinal cancer resection, or gynecological myomectomy, surgeons need to establish 2–5 working channels through the abdominal wall using disposable trocar sets. Among these, the most critical "initial port" (mostly a 10 mm or 12 mm observation port) is usually located at the umbilicus or the upper left abdomen, with the rest being 5 mm or 12 mm auxiliary operating ports.

The layout for a typical four-port laparoscopic cholecystectomy is as follows: the observation port is located above or below the umbilicus (10/12 mm trocar); the main operating port is 2–4 cm below the xiphoid process, slightly to the right of the midline (5 mm or 12 mm); auxiliary operating ports are placed below the right costal margin along the mid-clavicular line (5 mm) and in the left lower abdomen (5 mm). The distance between ports should be > 8 cm to avoid "clashing" of extracorporeal instruments, and the distance from the observation port to the target organ must ensure an appropriate viewing angle for 30° or 0° scopes. For obese patients with thick abdominal walls, extended-length (≥ 100 mm) trocar sets can be selected; for pediatric or thin patients, short types (75 mm) are used.

The操作流程 (operational procedure) is divided into two categories: closed (Veress pneumoperitoneum method) and open (Hasson method). The closed method involves first establishing an artificial pneumoperitoneum with a Veress needle (intra-abdominal pressure reaching 12–14 mmHg). After confirming the needle is correctly positioned, a small incision (mostly 2–3 mm) is made. The disposable trocar set, assembled with the obturator, is pressed vertically (90°) against the abdominal wall. The surgeon uses the thenar eminence to brace the end of the handle, with the index and middle fingers supporting the proximal end of the cannula. The wrist rotates with slight pressure to slowly advance forward-the key is to sense the "give/breakthrough sensation" (the sudden drop in resistance at the moment of penetrating the peritoneum), immediately stop advancing, withdraw the obturator, confirm gas return by aspiration or verify the position by inserting the laparoscope, and then tighten the fixing ring.

The second and third ports should be punctured under direct vision with the scope, avoiding the inferior epigastric artery (which can be assessed with transillumination) and areas of previous surgical adhesions. Bladeless or optical disposable trocar sets have obvious advantages at this stage: they bluntly separate fascial muscle fibers rather than cutting them, reducing bleeding; the transparent obturator tip,配合 (coordinated with) a 0° scope, allows real-time visualization of the separation of each abdominal wall layer, minimizing the risks of blind puncture.

Usage precautions: Do not violently hammer the puncture device; for tough and thick abdominal walls, slightly withdraw and then screw forward; after puncture, promptly close the sealing caps of unused ports to prevent air leakage; at the end of the procedure, first deflate the pneumoperitoneum before withdrawing the set to prevent rapid decompression from causing visceral herniation into the port. Standardized operation配合 (combined with) high-quality disposable trocar sets can achieve a first-attempt puncture success rate of over 95% and significantly reduce the accidental injury rate to blood vessels and bowels.

For operating room nurses, preparing the corresponding specification combination sets in advance according to the procedure (e.g., 1×12 mm + 3×5 mm or 2×12 mm + 2×5 mm), checking the integrity of the packaging and expiration dates, and assisting the surgeon in confirming the airtightness of each channel during the procedure are important links in ensuring the efficient turnover of back-to-back surgeries.