The New Fexible Trocar for Single Port Surgery

M. Yamagata, title, M. Matsuda, title, S. Hayashi, title, K. Hagiwara, MD, T. Takayama, PhD. Department of digestive surgery,Nihon Universuty

SPG spreads explosively now. However, maximal problem is in single port surgery that all of the operation is performed from an isologues direction and operative degree of difficulty increase with distance between navel and target organ.
for example, Appendectomy and colostomy were comparatively easy for short distance from navel, but operation for esophagus ,stomach and gall bladder were more difficult because in these operation comparatively had a long distance from a navel, If the operation will be performed from an isologues direction, pre-bend instruments will be necessary for changing vector of dissection and traction.
In the present time, disposable flexible forceps were already derived but these instruments were more expensive, and Flexibility of Energy device is not satisfactorily.
In Second generation of Single port surgery, Flexible instruments or flexible trocar is crucial factors. By change way of thinking, we developed the specific structural flexible trocar made by silicon and wire. All kinds of this trocar are disposable.
Types of trocar are 2type. First type has no air inlet with cock, other type has side cock. And diameters of trocar were 5mm, 10mm, 15mm, respectively, and lengths of trocar were 60mm, 100mm, 150mm respectively.
In insertion of second or third trocar, it is very difficult to confirm tip of trocar, by endoscopy, so dangerous blind insertion was sometimes performed. The insertion of this trocar to peritoneal cavity uses Seldinger’s method which use by angiography, it is for prevent injury of peritoneal organ, so this method of insertion to peritoneal cavity is become to more safety compared with direct insertion. As other characteristics of this trocar, we can insert any shape of flexural forceps to peritoneal cavity by using this trocar.An operator can set any Vector of manipulation and traction by using this trocar with pre-bend instruments. And dissection of Vessel and Duct will become easy, so stress of an operator will be relieved.
It is necessary enough training, the first Step of training is dry lab. for making image of movements in pre-bend instruments. And second step is simulation by wet lab, because movement of pre-bend instruments were extremely different compared with normal procedure.    
Finally, Our trocar have benefits that ,we can use reusable pre-bend instruments ,as a result, opportunity of using disposable flexible instruments will be decreased ,so that cost performance will be improved. In addition, we could apply this trocar with flexural forceps to even normal procedure and reduced port surgery.
 

View Poster