C. Tanaka1, M. Fujiwara1, M. Kanda1, M. Hayashi1, D. Kobayashi1, S. Yamada1, H. Sugimoto1, T. Fujii1, Y. Kodera1 1Nagoya University Graduate School Of Medicine,Dept. Of Gastroenterological?Surgery,Nagoya, AICHI, Japan
Introduction: ~The optical trocar access is one of techniques for the first trocar placement in laparoscopic surgery. By the optical trocar access, each tissue layer can be visualized prior to penetration, leading to prevention of organ injury, and air leaks at the site of trocars can be minimized even in obese patients. The aim of this study is to report the comparison of the required time for a trocar insertion between the optical trocar access and open group in patients who underwent laparoscopic gastrointestinal surgery.
Methods: ~We reviewed our prospectively collected database and identified 384 patients who underwent the laparoscopic gastrointestinal surgery for whom the initial trocar was inserted nearby the umbilicus either by the optical trocar access or by the open method. Prior to comparison between the two methods, the propensity score matching was used to adjust for essential variables between the optical trocar access and open groups. After matching, we compared the influences of age, sex, BMI, comorbidity, history of abdominal surgery, type of diseases and surgeon’s experience of the optical trocar access on required time for an initial trocar insertion. BMI was categorized into not obesity (<25 kg/m2) or obesity (≥ 25 kg/m2).
Results:~Patients categorized either as optical trocar access or open group were matched one-to-one by the use of propensity score matching and 137 pairs of patients were generated. The required time for a trocar insertion was significantly shorter in the optical trocar access group in comparison with that of the open group (36.6 vs 209.8 seconds, respectively, P<0.01). The prolonged time for an initial trocar insertion of optical trocar access was significantly associated with younger age of the patient and surgeon’s experience of 30 cases or fewer in the univariable analysis. The multivariable analysis identified the small experience of the surgeon as the only independent risk factor for prolonged time for an initial trocar insertion (OR 3.45, 95% CI 1.49 – 8.33, P <0.01; Table 2). Notably, BMI and history of abdominal surgery did not significantly affect the required time for a trocar insertion in the optical trocar access group. On the other hand, the prolonged time for an initial trocar insertion of open group was significantly associated with body mass index (OR 3.22, 95% CI 1.22 – 8.90, P = 0.02) and history of abdominal surgery (OR 2.96, 95% CI 1.27 – 7.12, P = 0.01).
Conclusion:~This study indicated that optical trocar access may be recommended for insertion of initial trocar in laparoscopic gastrointestinal surgery.