A neglected but frustrating ergonomic issue: the thoracoscopic trocar

One of the problems encountered during thoracoscopic operations is the frequent soiling of the endoscope by blood dripping along the trocar sheath. This study was conducted in order to evaluate the reality of this problem. The study consisted of three parts: a questionnaire was sent to surgeons performing thoracic procedures, data were collected during thoracoscopic operations, and a literature study was done in the patents index. The questionnaire was sent to 210 surgeons. Sixty-eight of them replied. During 44 operations the following data were recorded: Type and duration of the operation, number of times the lens and the trocar had to be cleaned. On the Internet and in a patents index [1] a search was conducted with the key words "thoracoscopy", "trocar" and "bleeding". All solutions for the problem mentioned above were listed. Ninety-seven percent of surgeons answered and recognised the problem: 68% of the respondents considered it is a troublesome one. Data were collected during 44 operations. In 41% of the operations the problem did not occur, which means it was not necessary to clean either the lens or the cannula. In 34% it happened one to two times and in 25% of the procedures it occurred even more often. If it occurred, the scope had to be cleaned on average once in about 10 minutes and the trocar had to be cleaned once in about 15 minutes. The longer the operation lasted the more often the lens and/or the trocar had to be cleaned. Out of the 11 procedures that lasted less than 15 minutes, the trocar was never cleaned, and the lens had to be wiped only 0.18 times per procedure. Out of the 18 procedures that lasted more than 20 minutes, the lens was cleaned 2.8 times per procedure and the trocar 1.6 times per procedure. Soiling of the endoscope during thoracoscopic procedures is a real concern that calls for new technical solutions in order to make video-assisted thoracic surgery safer for the patient and more pleasant to the surgeon.