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Related Experiment Videos

Trocar injuries in laparoscopic surgery.

S Bhoyrul1, M A Vierra, C R Nezhat

  • 1Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.

Journal of the American College of Surgeons
|June 13, 2001
PubMed
Summary

Disposable trocars with safety shields do not prevent injuries. Analysis of Food and Drug Administration data shows vascular and bowel injuries are significant risks, with delayed diagnosis increasing lethality.

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Area of Science:

  • Surgical Safety
  • Medical Device Analysis
  • Laparoscopic Surgery

Background:

  • Disposable trocars with safety shields are standard for laparoscopic access.
  • Analysis of Food and Drug Administration (FDA) data was conducted to identify risk factors for trocar injuries.

Purpose of the Study:

  • To analyze risk factors associated with injuries from disposable trocars with safety shields.
  • To investigate the types and causes of injuries reported to the FDA.

Main Methods:

  • Analysis of 629 trocar-related injury reports submitted to the FDA between 1993 and 1996.
  • Categorization of injuries into vascular, visceral, and abdominal wall hematomas.

Main Results:

  • Major vascular injuries (408) and bowel injuries (182) were most common. Safety shields were involved in 87% of fatal vascular injuries and 91% of bowel injuries.

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  • Vascular injuries accounted for 81% of deaths; bowel injuries for 19%. Delayed diagnosis of enterotomy led to a 21% mortality rate.
  • Device malfunction was rarely the cause of injury; surgeon technique was implicated more often.

    • Conclusions:

    • Safety shields and direct-view features on trocars do not prevent serious injuries.
    • Retroperitoneal vascular injuries are largely preventable with proper surgical technique.
    • Unrecognized bowel injuries are highly lethal; prompt diagnosis is critical.