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. 2023 Sep;37(9):7325-7335.
doi: 10.1007/s00464-023-10240-5. Epub 2023 Jul 13.

The influence of prolonged instrument manipulation on gas leakage through trocars

Daniel Robertson #  1 , Matthijs van Duijn #  2 , Alberto Arezzo  3 , Yoav Mintz  4 ; Technology Committee of the EAES; Tim Horeman-Franse  2
Collaborators, Affiliations

The influence of prolonged instrument manipulation on gas leakage through trocars

Daniel Robertson et al. Surg Endosc. 2023 Sep.

Abstract

Background: During laparoscopic surgery, CO2 insufflation gas could leak from the intra-abdominal cavity into the operating theater. Medical staff could therefore be exposed to hazardous substances present in leaked gas. Although previous studies have shown that leakage through trocars is a contributing factor, trocar performance over longer periods remains unclear. This study investigates the influence of prolonged instrument manipulation on gas leakage through trocars.

Methods: Twenty-five trocars with diameters ranging from 10 to 15 mm were included in the study. An experimental model was developed to facilitate instrument manipulation in a trocar under loading. The trocar was mounted to a custom airtight container insufflated with CO2 to a pressure of 15 mmHg, similar to clinical practice. A linear stage was used for prolonged instrument manipulation. At the same time, a fixed load was applied radially to the trocar cannula to mimic the reaction force of the abdominal wall. Gas leakage was measured before, after, and during instrument manipulation.

Results: After instrument manipulation, leakage rates per trocar varied between 0.0 and 5.58 L/min. No large differences were found between leakage rates before and after prolonged manipulation in static and dynamic measurements. However, the prolonged instrument manipulation did cause visible damage to two trocars and revealed unintended leakage pathways in others that can be related to production flaws.

Conclusion: Prolonged instrument manipulation did not increase gas leakage rates through trocars, despite damage to some individual trocars. Nevertheless, gas leakage through trocars occurs and is caused by different trocar-specific mechanisms and design issues.

Keywords: Laparoscopic model; Trocar leakage; Trocar manipulation.

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Conflict of interest statement

Mr Daniel Robertson, Mr Matthijs van Duijn, Dr Alberto Arezzo, Dr Yoav Mintz, and Dr Tim Horeman-Franse have no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
A Schematic of the experimental setup. 1: Laparoscopic instrument, 2: linear stage, 3: trocar, 4: pulley frame, 5: trocar Mount, 6: distance sensor, 7: weight, 8: airtight container, 9: flow sensor, 10: differential pressure sensor, 11: insufflator. B Overview test setup. 1: acrylic container, 2: insufflator, 3: laptop running LabView, 4: static load, 5: flow sensor, 6: trocar mount, 7: linear stage, 8: laparoscopic instrument, 9: Arduino UNO R3 microcontroller
Fig. 2
Fig. 2
Visualization of the raw, smoothed flows, and pressure inside the trocar. A Example of static flow measurement. B Dynamic flow measurement
Fig. 3
Fig. 3
Median leakage during manipulation per trocar. Trocar numbers indicated with * were only tested with a 10-mm instrument
Fig. 4
Fig. 4
Median leakage during manipulation per trocar. Trocar numbers indicated with * were only tested with a 10-mm instrument
Fig. 5
Fig. 5
Median differences before and after manipulation per trocar calculated by subtracting the static baseline measurement from the static control measurement. Trocar numbers with * indication were only tested with a 10-mm instrument
Fig. 6
Fig. 6
Observed damage to trocars after inspection. A Tear in the upper valve of trocar 1. B Visible damage to the lower valve of trocar 24
Fig. 7
Fig. 7
Comparison of unloaded versus loaded manipulation of trocar 1
Fig. 8
Fig. 8
Expelled soap bubbles showing leakage between the head and body of trocar 17
See this image and copyright information in PMC

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