A M Ternamian1, M Deitel. 1. Department of Obstetrics and Gynecology, St. Joseph's Health Centre, Toronto, ON, Canada. artin@pathcom.com
Abstract
BACKGROUND: A laparoscopic access system was developed for primary port insertion. The cannula requires no trocar and no axial penetration force during insertion. It provides magnified visualization through the scope on the monitor during access and exit. The device has a proximal valve section and a distal cannula section with a single thread winding around its outer surface, ending in a blunt tip. After umbilical incision and Veress insufflation, a 0 degrees laparoscope is mounted in the cannula. The tip of the cannula is inserted into a tiny fascial incision and rotated clockwise. The fascia and then the muscle fibers spread radially and are transposed onto the cannula's outer thread. The thin peritoneum transilluminates; bowel, vessels, and/or adhesions are visualized before entry into the peritoneum. METHODS: The cannula was used in 234 consecutive patients: 8.1% were markedly obese, with a body mass index (BMI) > or =35, 14.8% were moderately obese (BMI 30 to <35), and 77.1% were mildly obese or normal (BMI <30). RESULTS: There were no instrument-related or insertion-related complications. No insertion failed. Insertion time was slightly longer in the morbidly obese patients who had had previous umbilical surgical incisions. No port-site hernias have been found thus far (follow-up 6-48 months). CONCLUSION: This reusable cannula was found to be safe for any body weight.
BACKGROUND: A laparoscopic access system was developed for primary port insertion. The cannula requires no trocar and no axial penetration force during insertion. It provides magnified visualization through the scope on the monitor during access and exit. The device has a proximal valve section and a distal cannula section with a single thread winding around its outer surface, ending in a blunt tip. After umbilical incision and Veress insufflation, a 0 degrees laparoscope is mounted in the cannula. The tip of the cannula is inserted into a tiny fascial incision and rotated clockwise. The fascia and then the muscle fibers spread radially and are transposed onto the cannula's outer thread. The thin peritoneum transilluminates; bowel, vessels, and/or adhesions are visualized before entry into the peritoneum. METHODS: The cannula was used in 234 consecutive patients: 8.1% were markedly obese, with a body mass index (BMI) > or =35, 14.8% were moderately obese (BMI 30 to <35), and 77.1% were mildly obese or normal (BMI <30). RESULTS: There were no instrument-related or insertion-related complications. No insertion failed. Insertion time was slightly longer in the morbidly obesepatients who had had previous umbilical surgical incisions. No port-site hernias have been found thus far (follow-up 6-48 months). CONCLUSION: This reusable cannula was found to be safe for any body weight.