Ports, Trocars/Cannulae, and Access Techniques

One of the keys to safe laparo-endoscopic surgery is an expeditious, reliable, and safe access to the operative field. Aside from appropriate surgical technique, the technology of trocars, cannulae, and other endoscopically guided insertion techniques plays a decisive role for safe identification of and access to the peritoneal cavity. This report takes a close look at critical features of trocar and cannula design for blind insertion with the focus on the biomechanical principles involved in traversing the abdominal wall. Particular attention has been paid to techniques minimizing the risk of accidental injury to major vessels, intestine, and other important structures. The principle of controlled visualized access led to several developments in the field of trocars, cannulae, and puncture techniques. Aside from blind and open access with the Veress needle, conventional trocars and cannulae, a selected variety of endoscopically assisted ports such as the optical Veress needle, optical trocars and optical scalpel, and a vacuum-supported access system are described in detail.