Four Major Puncture Methods of Disposable Laparoscopic Trocar

The widespread adoption of minimally invasive surgery has significantly reduced surgical risks. However, puncture during laparoscopic surgery remains a notable risk, particularly the insertion of the pneumoperitoneum needle and the first trocar. Statistics indicate that about 50% of laparoscopic-related complications are related to puncture. Although intestinal or major vascular injuries from puncture are rare, such complications can be life-threatening. This article introduces four common laparoscopic puncture methods to help novice doctors master puncture techniques, with a particular focus on the usage points of the disposable laparoscopic trocar.

Closed Puncture Method with Disposable Laparoscopic Trocar (Veress Needle Technique)

The closed puncture method, also known as the classic puncture mode, is one of the most common puncture techniques. In this method, the doctor first punctures at the umbilicus using a pneumoperitoneum needle. Once the pneumoperitoneum is established, the disposable laparoscopic trocar is inserted. The advantage of this method is its relative safety and applicability to most laparoscopic surgeries. However, its disadvantage lies in the "blind puncture", which can easily cause injury to retroperitoneal vessels, abdominal wall vessels, and the gastrointestinal tract. For novice doctors, improper operation may result in a higher risk of complications.

To minimize this risk, the correct use of the disposable laparoscopic trocar is crucial. Physicians need to carefully select the puncture site after establishing the pneumoperitoneum and improve puncture accuracy through professional training to effectively avoid damage to visceral organs.

Open Puncture Method with Disposable Laparoscopic Trocar (Hasson Technique)

The open puncture method is mainly used for high-risk patients with a history of abdominal surgery, during pregnancy, or suspected of having intraperitoneal adhesions. In this method, the doctor first cuts through various layers of tissue at the umbilicus and then inserts the disposable laparoscopic trocar. The advantage of this method is that the operation process is visualized, making the puncture safer. It is particularly suitable for patients with complex internal abdominal structures. However, the downside of the open puncture method is that it takes longer, and if the incision is too large, it may cause gas leakage.

When using the disposable laparoscopic trocar for open puncture, it is essential for doctors to pay special attention to controlling the size of the incision to ensure the smooth insertion of the trocar and maintain stable pneumoperitoneum. Although challenging, with appropriate preoperative preparation and proficient handling of the trocar, doctors can effectively reduce risks and improve surgical efficiency.

Direct Insertion Method with Disposable Laparoscopic Trocar

The direct insertion method is a highly technical puncture technique suitable for experienced doctors. This method does not require prior establishment of the pneumoperitoneum but instead directly inserts the disposable laparoscopic trocar. Since the direct insertion method requires doctors to have a high degree of understanding of the abdominal wall layers and visceral positions, it is quite challenging. The trocar should be introduced at a 90° angle to the abdominal wall; after piercing the fascial layer, adjust to a 45° angle relative to the horizontal plane and slowly enter the abdominal cavity.

Although the direct insertion method has the advantage of reducing operation time, it carries a higher risk, especially for novice doctors. Correct use of the disposable laparoscopic trocar is the key to successfully completing the direct insertion method. Physicians must ensure precise control of the puncture angle and depth to avoid damaging critical organs.

Direct Visualization Method with Disposable Laparoscopic Trocar

The direct visualization method is a safer puncture technique, generally using a disposable visual separation trocar. In this method, the doctor first makes a skin incision and inserts a laparoscope into the disposable laparoscopic trocar. The entire puncture process is performed under visual guidance. By observing the dissection of various abdominal wall layers, doctors can effectively avoid damaging internal organs, thus ensuring surgical safety.

The direct visualization method is relatively less challenging, making it very suitable for novice doctors. This technique is not only easy to perform but also significantly improves the accuracy of using the disposable laparoscopic trocar due to visual assistance, effectively reducing the risk of puncture-induced complications.