Radially expanding dilatation. A superior method of laparoscopic trocar access.

Trocars used in laparoscopic surgery occasionally produce serious complications, such as bleeding, visceral injury, or incisional hernia. We report the evaluation of a new, potentially safer laparoscopic access device in which the cutting obturator of a standard trocar is replaced by a blunt, radially expanding device. Conventional and radially expanding trocars were used in laparoscopic cholecystectomies in 12 pigs. Their abdominal walls were excised and the defects caused by the trocars were examined. The defects caused by the radially expanding devices were about 50% narrower (P < 0.001), and the incidence of abdominal wall bleeding was considerably less (0% vs 21%) with the radially expanding trocars. Since incisional hernias at trocar sites are related to the size of the abdominal wall defect, the use of radially expanding trocars should decrease the incidence of this complication. There should also be less risk of visceral injury.