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Searching For The Safest Port

Mon, 08/22/2005 - 9:39am

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ConMed Corporation’s OnePort Trocar System works as four systems in one.

It started out as a convenient way for gynecologists to perform diagnostic analysis of the female reproductive organs. Now, some twenty-five years later, laparoscopy has extended well beyond gynecology and is becoming the method of choice for countless procedures. Everything from hernia repair to certain heart surgeries can be performed laparoscopically, with this minimally invasive approach resulting in reduced recovery times and better outcomes for patients.

The concept itself is pretty simple, instead of opening up the abdomen to allow the surgeon access, a camera, light, and any required instruments are introduced into the abdomen via small incisions. The surgeon can view and magnify the image of the surgical site provided by the camera on a monitor either within or outside of the sterile field. This technology has opened up a whole new world of advancements, including telesurgery and robotic surgery.

 


Ethicon Endo-Surgery’s ENDOPATH Xcel Trocars deliver hassle-free precision and efficiency during procedures.

Of course, one of the most crucial steps required in any laparoscopic surgery is gaining access to the abdominal cavity and establishing a port of entry. This remains one of the riskiest parts of the procedure. Access is generally achieved using a trocar encased in a sleeve or cannula. The central trocar, or obturator, is used to pierce the abdominal wall and is then removed leaving the cannula as an access port to abdominal cavity. From there, the surgeon has complete visual access via a camera system.

The risk, though, lies with the initial entrance into the abdominal cavity. This is the one part of the procedure that the surgeon often has to perform blind, unable to see the pierced tissue or what lies directly beneath it. While there are a broad range of styles and types of trocars currently on the market, many have sharp tips or blades to help them through the abdominal wall. The sharp tips and edges, combined with the penetration force required from the surgeon to cut into the abdomen, present a number of risks, such as cutting an artery or injuring the bowel. Fortunately, a number of medical device manufacturers who produce trocars have been developing safer systems and techniques to assist the surgeon in setting up a port of entry into the abdominal cavity while reducing the risk of injury to the patient.

 


Applied Medical’s Interchangeable
Abdominal Access System.

Applied Medical

Applied Medical’s (Rancho Santa Margarita, CA) Abdominal Access System offers hospitals complete flexibility while maintaining the benefits of standardization. All of the components are interchangeable, allowing an ideal mix of reusable and disposable cannulas and obturators, while accommodating individual surgeon’s preferences for either bladed or non-bladed systems. The competitively priced Abdominal Access System provides superior clinical performance, versatility and value.

Applied’s Separator® access system utilizes the company’s Sequential Helix™ technology, which separates muscle fibers along their natural planes, deflecting vessels and reducing tissue trauma. The technology effectively minimizes the resulting fascial defect, as well as the risk of potential herniation.

 


Applied Medical’s Optical Separator System provides clear visibility during insertion..

The Optical Separator system combines Applied's Sequential Helix technology with optical capabilities. By accommodating a laparoscope, the Optical Separator system provides exceptionally clear visibility of individual tissue layers as they are gently separated during insertion, adding an additional level of safety and accuracy to the port’s placement.

 


The 15-mm Separator from Applied Medical allows the introduction of instruments, gastric bands,
and more without loss of pneumoperitoneum.

The 15-mm Separator system is a non-bladed access port featuring Applied’s Universal® seal. This port’s innovative design allows the introduction of 5-mm instruments, gastric bands, large staplers, and morcellators, without the loss of pneumoperitoneum. The precedent-setting Universal seal is featured in Applied’s complete line of abdominal access products.

Ethicon Endo-Surgery, Inc.

Ethicon Endo-Surgery (Cincinnati, OH) offers an extensive selection of trocars to assist with virtually any minimally invasive access requirement. Building beyond their original TRISTAR Trocars, Ethicon has broadened its line of trocars to include bladeless, large port, dilating tip, and other access port options. The most recent addition to their trocar product line, the ENDOPATH® Xcel™, is the result of over three years of designing, aimed at meeting the need of the most demanding procedures and surgeons.

The ENDOPATH Xcel trocar is engineered to facilitate hassle-free precision and efficiency during surgical procedures. Available in bladeless and blunt tip configurations, Xcel is designed to stay in place and eliminate instrument hang-ups while offering reduced instrument drag force. Both configurations feature an improved durable seal that ensures constant insufflation and minimizes bodily fluid transfer to the camera lens.

ConMed Corporation

The OnePort line of trocars from ConMed Corporation (Utica, NY) provides laparoscopic surgeons with greater control, while reducing overall cost. The 11-mm and 12-mm trocars sleeves utilize an integral universal seal technology that permits all sizes and types of cannulas, from pediatric to bariatric, to fit the seal without the additional cost of add-on adapters.

Essentially, the OnePort trocar system is four systems in one. The trocars and cannulas are available in disposable or reusable versions with bladed or dilating tips and variations in style, such as ribbed or smooth cannulas in several lengths and diameters. By standardizing on the OnePort, hospitals can significantly cut costs by ordering and stocking one flexible line versus multiple brands, styles, and sizes.

TAUT, Inc.

The ADAPt™ Asymmetrical Dilating Access Port, developed by TAUT, Inc. (Geneva, IL) features an asymmetrical dilating tip designed to divide tissue along fascial fibers. This technology also helps to retain the fascial tensions that grip the cannula and minimize slippage. The ADAPt port has been designed to require minimal insertion force, seeking the path of least resistance through the fascia. As the tip is rotated, it dissects through each fascial layer and the peritoneum. The result is a small slit-like defect, low insertion pressure, and a port that stays in place. An extremely smooth transition between the obturator and cannula helps eliminate friction and eases insertion throught the dilated fascial tissue. The ADAPt also utilizes a unique rotary valve that fully retracts and protects the seal, leaving the cannula wide open. This unobstructed position facilitates intracorporeal suturing and passage of needle drivers, insertion of hernia mesh, removal of hooked or curved instruments, specimen retrieval, drain placement, and flexible endoscopy.

Patton Surgical Corporation

Patton Surgical Corporation’s (Austin, TX) PassPort™® Shielded Trocar offers double protection with its patented dual shield technology that provides smooth, controlled penetration but blunt entry. The primary tip shield immediately covers the cutting tip upon entry into abdominal cavity, shifting the tip from sharp to blunt and providing protection against bowel injury as the trocar is extended further into the abdominal cavity. The trocar is also equipped with a secondary blade shield that activates to cover the remaining blade edges prior the plunge effect that occurs when a decrease in resistance is experienced. Available in 5-mm, 10-mm, and 12-mm sizes, the Passport Shielded Trocar offers control and ease of use.

The Passport Trocar also features the exclusive Funnel® Cannula for easy instrument insertion and exchanges. The Funnel Cannula is equipped with a cut restraint valve system that withstands repeated instrument exchanges, and its Cap-Valve assembly is easily removed and replaced for specimen retrieval and gas evacuation. In addition to standard obturator/cannula packs, Patton Surgical offers the Funnel Cannulas in individual sterile packs, significantly reducing costs on second and third port placements.

The benefits of laparoscopic surgery have been well known for some time, and as the procedures advance, it is safe to assume that patient outcomes, recovery times, and overall cost efficiency will get better as well. As more and more surgeons and specialties move to minimally invasive approaches, medical device manufacturers and marketers are rising to the occasion and helping to advance the technology that is advancing surgery itself. In the case of trocars, this means taking some of the risk and danger out of one of the most crucial steps in laparoscopy—the initial access.

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