Cutting versus conical tip designs.

Abstract

The history of development in laparoscopy shows that the dilemma involving blind insertion of the trocar has not changed in over 100 years. Perforation of the abdominal wall with the cutting trocar is no longer necessary with today's anatomical and technical possibilities. The cutting trocar with its four cutting surfaces has a great disadvantage compared to the conical trocar with regard to safety. The linea alba should not be disrupted, and perforation of the abdominal wall should be performed in an area where the fascia is weaker and muscle is more abundant. The "z"-track method of trocar insertion prevents intestinal or omental herniation. For perforation and stretching of the muscle, a conical trocar with a blunt tip is recommended. After inserting the conical trocar down to the layer of subcutaneous fat or muscle, further advancement is performed under visual control using a normal straight endoscope and by rotating the bevelled end of the trocar sheath. Perforation of the abdominal wall with a conical trocar using the "z"-track incision under endoscopic control prevents incisional herniation of intestine or omentum.