May. 06, 2024
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Disposable trocars Laparoscopic instruments for insertion through trocarsA trocar (or trochar) is a medical or veterinary device used in minimally invasive surgery. Trocars are typically made up of an awl (which may be metal or plastic with a pointed or tapered tip), a cannula (essentially a rigid hollow tube) and often a seal. Some trocars also include a valve mechanism to allow for insufflation. Trocars are designed for placement through the chest and abdominal walls during thoracoscopic and laparoscopic surgery, and each trocar functions as a portal for the subsequent insertion of other endoscopic instruments such as grasper, scissors, stapler, electrocautery, suction tip, etc. — hence the more commonly used colloquial jargon "port". Trocars also allow passive evacuation of excess gas or fluid from organs within the body.
The word trocar, also spelled trochar, originates from the French trocart or trocar, possibly derived from trois-quarts ('three fourths') or trois carres ('three sides'), referring to the instrument's triangular point. It was first documented in the Dictionnaire des Arts et des Sciences in 1694 by Thomas Corneille, the younger brother of Pierre Corneille.
Originally, doctors used trocars to relieve pressure due to fluid (edema) or gas (bloating). Patents for trocars were filed in the early 19th century, although their usage likely dates back thousands of years. By the mid-19th century, trocars had become more sophisticated, with Reginald Southey's invention of the Southey tube being a notable example.
Trocars are used in medicine to access and drain fluid collections like hydrothorax or ascites. In modern surgical practices, they are primarily used for laparoscopic procedures to introduce cameras and instruments such as scissors and graspers. Today’s trocars are usually single-use and feature advanced designs that enhance patient safety by minimizing trauma during insertion.
However, improper insertion can result in complications like bowel injury or hemorrhage, underscoring the importance of careful technique.
During the embalming process, trocars are used to drain bodily fluids and organs. They form a critical tool for the aspiration process, where gas, fluids, and semi-solids are removed from the body. Modern techniques often use a smaller trocar connected to a bottle of high-index cavity fluid to distribute chemicals evenly. Typically, a trocar button seals the puncture post-embalming.
Trocars are employed widely in veterinary medicine for various purposes, such as draining hydrothorax and ascites or introducing instruments during laparoscopic surgery. Veterinarians also use them for acute animal-specific conditions. For instance, a large-bore trocar may be used to relieve gas in cattle suffering from ruminal tympany. In dogs with gastric dilatation volvulus, a trocar can be essential for emergency decompression before surgical intervention.
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In its simplest form, a trocar is a pen-shaped instrument with a sharp triangular point at one end, typically used inside a hollow tube, known as a cannula or sleeve, to create an opening into the body through which the sleeve may be introduced to provide an access port during surgery.
The design of trocar instruments continues to evolve. Factors like material, edge design, and transparency can aid in easier placement within the abdominal or thoracic cavities. Clear tips, like those found in some modern trocars, facilitate laparoscopic entry. Some are designed as simple metal tubes with disposable plastic valves to maximize reusability.
Historically, trocars were documented as early as 30 AD by Aulus Cornelius Celsus in his medical encyclopaedia. The 1950s brought the dual trocar method, with significant contributions from German gastroenterologist Heinz Kalk.
Robotic trocars are minimalistic, acting as entry points for robotic instruments. These simple metal tubes have disposable plastic valves for reusability, and various designs ensure minimal trauma during placement into the body cavity.
Modern laparoscopic procedures often employ multiple trocars. A primary trocar creates a port for the laparoscope, while secondary trocars provide additional entry points for surgical instruments or aid in fluid drainage.
Laparoscopy involves inflating the abdomen with carbon dioxide to create separation between organs, providing more space for manipulation. Trocars serve as gateways for introducing various minimally invasive instruments. A gas-tight valve at the top prevents the escape of insufflated carbon dioxide, and various designs accommodate instruments of different diameters while minimizing gas leakage.
Both single-use and reusable trocars are available, each offering unique benefits. Reusable trocars, although cost-effective per use, can be challenging to sterilize. To address this, some manufacturers now offer hybrid designs combining reusable sleeves and single-use valve assemblies.
Sleeves come in various sizes, with non-reflective transparent versions available for better monitoring during insertion. Different tip designs, including pyramidal, flat double-edged, and pointed conical tips, offer varying benefits regarding ease of insertion and patient comfort. Innovations like spring-loaded plastic shields and pressurized gas curtains further enhance safety and reduce complications.
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