Prospective Assessment of Trocar-Specific Morbidity in Laparoscopy
Cristaudi, Alessandra ; Matthey-Gié, Marie-Laure ; Demartines, Nicolas ; Christoforidis, Dimitri
In: World Journal of Surgery, 2014, vol. 38, no. 12, p. 3089-3096
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- Background: The purpose of the present study was to challenge the hypothetical advantage of single port laparoscopy (SPL) over conventional laparoscopy by measuring prospectively the morbidity specifically related to conventional trocar sites (TS). Methods: From November 2010 to December 2011, 300 patients undergoing various laparoscopic procedures were enrolled. Patient, surgery, and trocar characteristics were recorded. We evaluated at three time points (in-hospital and at 1 and 6months postoperatively) specifically for each TS, pain (Visual Analog Scale), morbidity (infection, hematoma, hernia), and cosmesis (Patient Scar Assessment Score; PSAS). Patients designated their "worst TS,” and a composite endpoint "bad TS” was defined to include any adverse outcome at a TS. Results: We analyzed 1,074 TS. Follow-up was >90%. Pain scores of >3/10 at 1 and 6months postoperatively, were reported by 3 and 1% of patients at the 5mm TS and by 9 and 1% at the larger TS, respectively (5mm TS vs larger TS; p=0.001). Pain was significantly lower for TS located in the lower abdomen than for the upper abdomen or the umbilicus (p=0.001). The overall complication rate was <1% and significantly lower for the 5mm TS (hematoma p=0.046; infection p=0.0001). No hernia was found. The overall PSAS score was low and significantly lower for the 5mm TS (p=0.0001). Significant predictors of "bad TS” were larger TS (p=0.001), umbilical position (p=0.0001), emergency surgery (p=0.0001), accidental trocar exit (p=0.022), fascia closure (p=0.006), and specimen extraction site (p=0.0001). Conclusions: Specific trocar morbidity is low and almost negligible for 5mm trocars. The umbilicus appears to be an unfavorable TS.