Trocar Sets

Laparoscopy is a surgical procedure that has been widely used in medicine for over 30 years.¹ All minimally invasive procedures in the abdominal cavity have one thing in common: the use of trocars. They provide access to the body cavity and serve as a guide for the optics and instruments. The use of trocars has become commonplace in surgical, gynecological and urological operating rooms. Trocars are therefore standard instruments in minimally invasive surgery.²

Understanding Trocar Sets and Their Components

In essence, a 'Trocar Set' refers to the specific collection of individual trocars and their associated components, while 'Trocar Systems' can encompass the broader range of tools and technologies used to provide access during minimally invasive surgeries, including multiple types of trocars, cannulas, and complementary devices.
A wide variety of trocar sizes, both in length and diameter, and designs exist. The choice of trocars generally depends on the operative procedure being performed, surgeon preference, institutional availability, and specific experience.

Most trocar sets contain several key components, including:

• a hollow port
• an inner obturator that is removed after port placement
• an internal seal or valve to prevent the loss of pneumoperitoneum
• an external stopcock for managing insufflation

The goal of any trocar is to provide a simple means of accessing the operative field while maintaining pneumoperitoneum (the insufflation of air or gas into the abdomen). Ideally, a trocar, regardless of its type, would facilitate efficient access while minimizing complications such as hernia, bleeding, and damage to surrounding structures.³

Trocar Placement and Spacing in Surgery

Traditional laparoscopy and robotic surgery require proper spacing of trocars to triangulate instruments toward the target tissue. Generally, the optimal spacing is between 6 to 8 cm between individual trocars, improving ergonomics and reducing the risk of arm or instrument clashing. This distance is often approximated using the horizontal width of the surgeon’s hand.³

Reusable vs. Disposable Trocars

The decision to use reusable vs. disposable trocars is often based on cost. The expense of cleaning and repurposing reusable trocars must be weighed against the cost of purchasing disposable equipment.⁴

Blunt-Tip vs. Bladed Trocars

Many surgeons prefer blunt, dilating trocars over bladed, cutting counterparts. The advantage of blunt trocars is the smaller fascial defect they create, which can reduce the need for closure in some cases and lower the risk of port site hernias. Blunt trocars may also result in less access-related bleeding, as they push vessels and muscle aside, rather than cutting through them.⁵
In contrast, bladed trocars offer quicker intraperitoneal access, but often at the cost of safety, particularly in patients with a history of prior abdominal surgery. Most bladed trocars have a safety tip that covers the sharp blade and deploys when resistance is overcome, similar to the design of the Veress needle. Trocars with this feature are called safety trocars.⁶

Exploring Trocar Types: Balloon Trocars and More

In addition to blunt-tip and bladed trocars, other specialized types, such as balloon trocars, are used in certain procedures to enhance access. It is important to note that balloon trocars designed specifically for hernia repair are distinct from trocars with anchoring balloons, which create a secure seal in the abdominal wall to maintain pneumoperitoneum and prevent leakage during surgery. Each type serves a unique purpose, tailored to the requirements of different surgical contexts.

Concluding Thoughts on Trocar Sets

The choice of trocar sets is critical to the success of minimally invasive procedures. Understanding the differences between trocar types and their specific uses ensures that surgeons can perform operations safely and efficiently, reducing the risk of complications while optimizing patient outcomes.³

Studies:

¹Darwish A. (2011). Advanced Gynecologic Endoscopy. InTech, www.intechopen.com.
²Peitgen K. (2008). Trokare in der minimal-invasiven Chirurgie: Anwendung, Sicherheit und Komplikationen. CHAZ (Chirurgische Allgemeine Zeitung), 9.
³Gaunay G. S., et al. (2016). Trocars: Site Selection, Instrumentation, and Overcoming Complications. Journal of Endourology, 30 (8): 833-843.