A Novel Procedure for Introducing a Large Gauze Into the Corporeal Cavity With a Slim Trocar (tornado Procedure)

1. Objective of the technology: An intracorporeal gauze is used during laparoscopic procedures for hemostasis, blunt dissection, suction filtering, and organ retraction. The current laparoscopic technique involves an advanced, single-incision surgery or reduced port surgery that can be performed for certain organs. Small trocars are used during such surgeries. In such procedures, the gauze is introduced into the corporeal cavity by using a trocar, with the corner of the gauze held by a grasper. However, this method of introducing gauze is traditionally performed using 10–12 mm trocars; when a slim trocar (5 mm) is involved, the gauze should be very small and thin. When a large gauze is needed during a surgery where a slim trocar is used, the operation needs to be interrupted to introduce the gauze by incision or to change to a large trocar. We developed a novel procedure for introducing a large gauze into the corporeal cavity by using a slim trocar (5 mm), called the “Tornado procedure.”
2. Description of the technology: The commercially packed Trox gauze (30 x 150 mm, 4-ply with a radiopaque strip; Osaki Medical, Japan) is used for the Tornado procedure. This gauze has enough absorbing power and has been reported to be useful for laparoscopic surgery since 2004. However, it cannot be introduced into the corporeal cavity by using a slim trocar in the traditional procedure.The Trox gauze is screwed into an ethylene oxide gas–sterilized polypropylene (PP) tube (5.4 mm OD x 100 mm) by a scrub nurse during surgery(Fig.1). When the surgeon needs a gauze, a 5-mm grasper is used to take the gauze through its tail from the opening of the PP tube and then the 5 mm trocar is used to push the gauze into the corporeal cavity with screwing movements(Fig.2). Thus, the gauze can be smoothly introduced into the corporeal cavity(Fig.3). When the gauze needs to be replaced, the grasper is used to hold the corner of the Trox gauze, and the 5-mm trocar is used to gently remove it. The gauze is compressed and made smaller by forming a tornado shape. The frictional force between the gauze and the PP tube is also reduced by the gentle screwing movements. Hence, a large gauze may be smoothly introduced into the corporeal cavity by using a slim trocar.
3. Results: We used the Tornado procedure during a single-incision laparoscopic cholecystectomy(n = 8) and for single-incision transabdominal preperitoneal hernia repairs (n = 8). Because the procedure eliminated the need for interrupting the surgery, the operation times were reduced, and a good visualization and efficient blunt dissection were attained. The port’s valves were not disabled during surgery, and no procedure-related complications were reported.
4. Conclusions/Future directions:The Tornado procedure may also be applicable for introducing large, non-woven absorbable hemostat or fabric, or surgical mesh into the corporeal cavity during laparoscopic surgeries by using a slim trocar. This procedure should be helpful for surgeons and might help ensure the safety of laparoscopic surgeries involving the use of slim trocars.