10 Things to Consider When Buying What Is a Trocar Used for in Surgery

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Most surgeons don't invest a lot of time considering the question of how to select the optimal trocar kit for their patients.

They almost always have established preferences.

Purchasing agents and inventory managers for practices with multiple practitioners, on the other hand, spend a great deal of time making sure that each of their surgeons always has their preferred surgical tool for each of their patients. Trocar Supplies gives your practice the selection of trocars your surgeons prefer at prices that are friendly to your budget. We have the expertise to help you justify your selections when surgical needs require exceptions to your usual purchase orders. And when you surgeons have their own trocar design, we can even provide custom trocar kits to your specifications.

Components of a Trocar Kit

Here's a quick review of the components of every trocar kit to help you navigate thousands of items we have in inventory.

Every trocar kit has three parts:

• There's a cannula. This is the shaft the surgeon presses through the skin and fascia to reach a body cavity.

• There is also a seal. Located at the top of the cannula, the seal maintains pressure inside the body cavity by preventing the escape of gasses.

• And at the end of the trocar opposite the seal there is an obturator. The surgeon uses this part of the trocar to penetrate skin and connective tissue.

All these three components appear in every trocar, there is a reason that trocar are available in hundreds of specifications. Stocking the right trocars requires a basic understanding of what patients will need and surgeons will prefer at your clinic.

Assessing Patient Needs

It is not enough to master everything you need to know about trocars. Informed purchases require assessing patient needs.

Trocar-specific patient morbidity is a rare event. Infection, hematoma, hernia, post-procedural pain, and cosmetic concerns are almost unknown after the insertion of hormone pellets by trocar (although there are a few reports of complications after the surgeon chose the umbilicus for the point of insertion). In one clinical study involving 300 patients receiving various laparoscopic procedures, trocars with blade width of less than 5 mm resulted in complications in just two (fewer than 1 percent) of cases, both of them involving accidental trocar exit. Post-procedural cosmetic concerns are almost nil.

What to Consider When Choosing a Trocar Kit

Even when the primary use of trocar kits is the insertion of pellets for hormone therapy, individual differences in patients and individual preferences of physicians must be considered in choosing the best product.

Types of Trocars (Reusable vs Disposable)

Purchasing agents will notice that disposable trocar kits cost, on average, about 2/3 as much from the supplier as reusable trocars.

A disposable trocar is, by definition, used just once. A reusable trocar might be used hundreds or even thousands of times, with sterilization after every use and periodic sharpening following your clinic protocols. The calculation you need to make is the cost of the trocar plus the cost of sterilization, storage, sharpening, and inventory control, divided by the number of times your surgeons can be expected to use the instrument.

Typically, a reusable trocar doesn't save money unless it is used at least 10 times. However, there can be patient specific needs that affect the choice between single-use and reusable trocars for some patients. Some patients require single-use trocars.

For patients with bloodborne communicable diseases, multiple-use trocars are not an option. Patients with extensive adhesions after surgery or injury may also require a single-use trocar.

It is always possible to use a more expensive multiple-use trocar kit on a patient just once, but it is far more cost-effective for purchasing personnel to use historical data to calculate the minimum number of single-use trocar kits they need to keep in stock. Don't forget to order hormone pellet insertion kits that your doctors will need even when you reuse the trocar. They are available in packs of 20.

Sizes of Trocars

Trocar Supplies sells trocars with 3.2 mm blades, trocars with 3.5 mm blades, trocars with 4.5 mm blades, atraumatic blunt tip trocars, bevel tip trocars, diamond tip trocars, and pointed-tip trocar kits.

We offer our trocars with 3.2 mm, 3.5 mm, and 4.5 mm blades in both stainless steel and resin. Our traumatic blunt tip trocars are the instrument of choice when sealing the portal is a priority. Bevel tips minimize trauma to skin around the entry site. The diamond-shaped cutting edge offers a precise cutting edge. Pointed tips minimize trauma to connective tissue beneath the skin.

Your doctors may express a preference for one of these styles over others, but all are designed for minimal trauma from pellet insertion.

Size of the Pellets

Our devices come with 3.2 mm blades for insertion of 100 mg pellets and 4.5 mm blades for insertion of 200 mg pellets.

Desired Depth of Insertion

Trocar Supplies trocars create a tract of 8 to 10 mm for the insertion of the pellet.

Location of Insertion

Most patients prefer insertion of hormone pellets into the hip, although some women prefer to receive estrogen pellets in the lower abdomen.

Additional Factors to Consider

What else do purchasing agents need to consider when buying trocars?

Surgical Team's Opinion

Obviously, your doctors must be happy with the surgical tools you make available to them. We can help you field questions from your surgical team about the experiences of other healthcare providers with our products. We can share the national approvals for every product we sell. Trocar Supplies serves physicians and clinics in the United States, Canada, Brazil, and Argentina, and we are completing our registrations for sales in Australia and Asia,

If you want to learn more, please visit our website What Is Trocar Used for.

Trocar Kit Quality & Safety

Trocar Supplies is currently the only disposable trocar provider in the United States operating an ISO 13485 facility. We strictly adhere to FDA and GMP guidelines.

Cost

We offer discounts for volume sales. Ask us about your options for trocars manufactured to your specifications in quantities of 1000 or more. We also offer individual items on sale from time to time. Check our catalog frequently!

Choosing the Right Supplier

Trocar Supplies is a family-owned business in Ohio that has spent decades establishing a globally accepted standard of excellence for disposable trocars. We listen to our customers, and we have developed over 40 types of trocar kits with more on the way. We are treated with our own products, so we know how to keep both doctors and patients happy.

We are here to serve you. Send us your inquiries online, or call us at (937) 478-0469. Our offices are located at 126 Nulf Dr., Columbiana, OH 44408.

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Laparoscopic access systems have evolved greatly in the last decade. We have gone from reusable bladed trocars to disposable bladed and bladeless, from dilating trocars to bladeless optical-view trocars that let the surgeon visualize the trocar passing through the abdominal wall layer by layer. The goal of all these changes has been the same: achieving safe entry and creating the smallest possible defect in the abdominal wall fascia after removing the trocar.

Today's trocars require less force during insertion than before and cause less trauma to the fascia and other tissues. The less trauma that's used for insertion, the more likely the tissue will heal properly after the procedure. New innovations in trocar design have also greatly reduced the rate of injury during trocar insertion.

With the improvements in instruments and laparoscope design, we're able to use smaller diameter trocars for the majority of cases. Smaller incisions help reduce hernia rates and can result in less post-op pain. They can also save time, since a 5mm incision doesn't need a fascial closure. Another design improvement in trocars is a threading of the exterior to prevent slippage after initial placement.

All this evolution means that there's a lot of choice out there. Here are thumbnail sketches of many of the trocars used for general surgery.

Hasson and balloon trocars
Hasson trocars, the first modern trocars, named after Harrith Hasson, MD, are non-bladed trocars inserted using the open, or direct-cut, method. Direct cut is one of the most common and safest methods of laparoscopic access. The surgeon dissects the tissue layers to ensure safe entry into the abdomen. The trocar is then inserted under direct vision. Any case in which the trocar will be inserted at the umbilicus, such as laparoscopic cholecystectomy, Nissen fundoplication or splenectomy, would employ a Hasson trocar.

The Hasson trocar stays in place by way of sutures anchored in the abdominal wall fascia. These Hasson trocars are usually available only in 12mm versions. Reusable Hasson trocars were once common, but now most surgeons use disposable versions.

Balloon trocars can be used in place of Hasson trocars. The balloon trocar has a balloon that inflates at the end of the trocar with air from the room. The balloon anchors the trocar in the abdomen so that it doesn't need sutures in the fascia. Newer versions of balloon trocars are now latex-free for use in patients with latex allergies.

Optical access trocars
Until these trocars came along, the surgeon had to enter the abdomen "blind," without being able to see where the advancing tip of the obturator was going. As a result, the risk of complications used to be higher than today. Optical access trocars let you insert a laparoscopic camera in the trocar's hollow obturator. During insertion, the laparoscope lets the surgeon see the trocar going through the different layers of tissue as it moves its way into the abdomen. As the trocar dissects through the fascia and peritoneum, the surgeon can see it enter the abdominal cavity, helping to prevent organ injury.

Optical access trocars are good initial-entry trocars for procedures. Once the first trocar is in, the laparoscopic camera can be used inside the abdominal cavity to help with guidance for the insertion of other trocars.

Most optical access trocar systems are considered non-bladed trocars since they just have little plastic "wings" at the end of the obturator that help dissect and push the tissue out of the way.

Optical view trocars can be used before insufflation and can be used to insufflate the abdomen. All other trocars need a Veress needle for insufflation, except Hasson and balloon trocars, which are inserted through the direct-cut method and without insufflation.

Some systems have a special feature that lets you connect insufflation gas to the obturator. The gas then helps dissect the tissue as you go down through the layers.

Dilating trocars
Rather than slicing tissue, dilating trocars spread it apart. The advantage here is less damage to the tissue as the trocar goes through. The residual hole in the fascia is very small, and usually doesn't require closing. In most cases, these trocars require less force to insert because a needle surrounded by an expandable sheath is inserted first, creating a small hole. Then the needle is removed, leaving the sheath in the hole in the fascia. Inserting the trocar, which has a tapered end, into the sheath dilates the hole in the fascia created by the needle. The resistance of the dilated fascia against the sheath keeps the trocar in place so that the surgeon doesn't have to use sutures as anchors. Dilating trocars can be used as secondary trocars or, if a Veress needle is used to insufflate the abdomen beforehand, as initial trocars.

The advantage of the dilating trocar is that you don't have to close the larger 12mm ports, as you have to do for the cut-down method and other trocars of that size. Dilating trocars are suited for any case in which you need a stapler, endo catch bag, suturing device or any other device that only fits through a trocar 12mm or larger, including mesh for hernia repairs.

Bladed trocars
These use a sharp blade to cut through the tissue during insertion. Because they offer no visualization, they shouldn't be used as the initial trocar. Many surgeons have moved away from these trocars because the incidence of injury to the abdominal wall or abdominal organs can be high. However, bladed trocars still have a place in laparoscopic surgery. If you know you're going to close a fascial defect and need a trocar big enough for a certain instrument or to remove a specimen, the bladed trocar can be helpful in creating a hole in the fascia large enough for the instrument to pass through.

Non-bladed, non-optiview trocars
Like dilating trocars, these trocars push the tissue out of the way as the obturator advances. Pushing a blunt trocar through the tissue and fascia requires more force than using a dilating trocar. Although they're often called "bladeless," blunt trocars still cut some of the tissue. However, in general, blunt trocars are less traumatic than bladed trocars.

These inexpensive trocars are useful as secondary ports. Because they're not optical trocars, they usually cost less. After initial trocar placement, these can be used in almost any position and create very little in the way of fascial defects. They now come in 5mm, 10mm and 12mm sizes.

Single-use vs. reusable
Most trocars used in surgical facilities are disposable. However, many trocar systems are available in reposable (reusable) versions. Reposable trocars and obturators are usually made of a metal such as titanium that can be reprocessed. Some reposable systems have a disposable component that you need to replace each time. Maintaining the sharpness of the obturator tip in reposable trocars is a concern among some surgeons and facility managers. Reposable trocars also require special attention during reprocessing, as all cannulas do.

Innovations in trocars
One of the major frustrations of laparoscopic surgeons is the smudging of the laparoscope as it passes through the trocar valves. A few trocar systems designed to prevent smudging and fogging have hit the market. Two use an insufflator to create an air barrier, which eliminates the need for the trocar to have a valve to preserve intra-abdominal pressure. One drawback with these systems is that they're 12mm trocars, which means that the hole in the fascia should be closed when the trocar is removed.

Further development of smudgeless trocars would eliminate this time--consuming problem and would greatly ease the performance of surgeons in conducting laparoscopic procedures.

Minimally invasive surgery has come a long way but there are still a few challenges to overcome. We're getting there.

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