• Good fixation of trocar: is it necessary for endoscopic operations?

Good fixation of trocar: is it necessary for endoscopic operations?

PAEDIATRIC SURGERY.UKRAINE.2018.3(60):73-76; doi 10.15574/PS.2018.60.73

Axelrov M. A., Komarov A. P., Gorokhov P. A., Stolyar A. V., Emelyanova V. A., Kokotalkin A. A., Satyvaldayev M. N., Sergienko Т. V., Malchevsky V. A.
FSBEI of HE «Tyumen State Medical University of Ministry of Healthcare of the Russian Federation»
State Budgetary Health Institution of Tyumen Regional «Regional Clinical Hospital No.2», the Russian Federation
Federal Publicly Funded Institution of Science «Tyumen Scientific Centre of the SB RAS», the Russian Federation

Laparoscopic surgery has become the «gold standard» in the treatment of most surgical diseases and malformations in children. However, slipping out of the trocar sleeve during instrument changing, especially in infants, remains a problem.

Objective: to develop and implement a rapid and atraumatic fixation of trocar in the patient's soft tissues during the endoscopic operations in children.

Materials and methods. In total 53 endoscopic operative techniques were studied in children operated on oesophageal atresia, diaphragmatic hernia, duodenal atresia, hiatal hernia, hydronephrosis, vesicoureteral reflux, and bladder diverticulum. The average duration of surgeries was 110±15 minutes. All patients were infants. The 1st group consisted of 27 patients, in whom special fixation of the trocar during the surgical intervention was not provided, the 2nd group composed of 26 children with fixed trocar according to the developed method during the surgery.

Results. Slippage of the trocar sleeve during the instrument changing was recorded in children of the 1st group in 100%, in the 2nd group in 7.7%, which prolonged the time of surgical intervention and led to subcutaneous emphysema in 62.9% of cases in the 1st group and 3.8% in the 2nd group.

Conclusions. The lack of secure fixation of the trocar with a smooth long sleeve during the laparoscopic access can be qualified as a risk factor for complication of the operation, which reduced its efficiency and safety. The recommended trocar fixation during the endoscopic operations allows to exclude its slipping out and migration from the operating field, significantly reducing the risk of wound postoperative complications.

Key words: trocar, subcutaneous emphysema, children, malformations, laparoscopy, thoracoscopy, lumboscopy, vesicoscopy.

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Article received: Mar 12, 2018. Accepted for publication: Aug 30, 2018.