Safe Abdominal Entry Using a Round Tip Blunt Trocar – Insights from WALS 2025 by Dr R P Ramchandra скачать в хорошем качестве

Safe Abdominal Entry Using a Round Tip Blunt Trocar – Insights from WALS 2025 by Dr R P Ramchandra

At the 8th World Congress of Laparoscopic Surgeons (WALS 2025), Dr. Rotithor Pandurang Ramchandra delivered an enlightening talk on the importance of safe abdominal entry using a round tip blunt trocar. Entry into the peritoneal cavity is a critical step in laparoscopic surgery, and improper techniques can lead to complications such as vascular injuries, bowel perforations, and port-site hernias. The use of a round tip blunt trocar offers a safer alternative, minimizing the risks associated with conventional sharp trocars while ensuring smooth and controlled access. Challenges in Laparoscopic Abdominal Entry Abdominal entry is a high-risk step in laparoscopic surgery, contributing to a significant number of laparoscopy-related complications. Common issues include: 1. Vascular Injury – The inferior epigastric vessels, aorta, and iliac vessels are vulnerable during trocar insertion, particularly with sharp trocars. 2. Bowel and Omental Injury – Unintentional penetration of the bowel or omentum can occur, often leading to delayed recognition and serious consequences. 3. Gas Insufflation-Related Injuries – Excessive insufflation pressure during Veress needle entry may lead to subcutaneous emphysema or gas embolism. 4. Port-Site Hernia – Large defects from traditional trocars can increase the risk of hernia formation. The Round Tip Blunt Trocar: A Safer Alternative Dr. Rotithor Pandurang Ramchandra highlighted that the round tip blunt trocar is designed to minimize entry-related complications while maintaining effective and atraumatic peritoneal access. Its key advantages include: 1. Blunt Entry for Reduced Tissue Trauma – Unlike sharp trocars, the round tip blunt trocar gently displaces tissues rather than cutting through them, reducing the risk of vascular and bowel injury. 2. Controlled Peritoneal Access – The trocar applies gradual pressure, facilitating a safer and more predictable entry into the peritoneal cavity. 3. Lower Risk of Bleeding – Since it does not incise vessels like sharp trocars, the risk of port-site hematomas and bleeding is significantly reduced. 4. Reduced Risk of Adhesion Formation – Blunt trocars minimize tissue disruption, lowering the risk of postoperative intra-abdominal adhesions. 5. Enhanced Patient Safety in High-Risk Cases – Particularly beneficial for obese patients, patients with prior abdominal surgeries, and those with suspected intra-abdominal adhesions. Techniques for Safe Abdominal Entry Using a Round Tip Blunt Trocar Dr. Rotithor provided a structured approach to safe abdominal access using this innovative trocar: 1. Preoperative Planning • Ultrasound assessment can be useful in cases with previous abdominal surgeries to identify adhesions. • The supraumbilical or Palmer’s point entry should be considered in patients with high-risk anatomical variations. 2. Stepwise Entry Technique • Small skin incision: A minimal incision is made at the umbilicus or an alternative site. • Blunt trocar advancement: The round tip trocar is gently twisted and advanced in a controlled manner to separate tissue layers rather than puncturing them. • Real-time monitoring: The technique can be coupled with laparoscopic-assisted visual entry for enhanced safety. • Adequate pneumoperitoneum: Establishing proper insufflation before inserting secondary trocars further minimizes trauma. Limitations and Considerations While the round tip blunt trocar is highly effective, Dr. Rotithor Pandurang Ramchandra emphasized that surgeons must be trained in proper technique to maximize its benefits. Some potential considerations include: • Learning Curve – Requires familiarity and experience in controlled insertion techniques. • Cost Factor – May be slightly more expensive than conventional sharp trocars. • Force Application – Excessive force can increase resistance and create difficulty in entry; a steady, controlled approach is key. Conclusion The round tip blunt trocar presents a significant advancement in laparoscopic surgery, offering a safer and more controlled alternative to traditional sharp trocars. By reducing the risks of vascular injury, bowel perforation, and excessive bleeding, it enhances patient safety and surgical outcomes. The insights shared by Dr. Rotithor Pandurang Ramchandra at WALS 2025 reinforce the need for continued innovation and refinement in laparoscopic access techniques, ensuring safer and more effective minimally invasive surgeries in the future. ⸻ Would you like any modifications or additional references?