Prospective assessment of trocar-specific morbidity in laparoscopy.

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Serval ID
serval:BIB_E9478CA74A96
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Prospective assessment of trocar-specific morbidity in laparoscopy.
Journal
World journal of surgery
Author(s)
Cristaudi A., Matthey-Gié M.L., Demartines N., Christoforidis D.
ISSN
1432-2323 (Electronic)
ISSN-L
0364-2313
Publication state
Published
Issued date
12/2014
Peer-reviewed
Oui
Volume
38
Number
12
Pages
3089-3096
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
The purpose of the present study was to challenge the hypothetical advantage of single port laparoscopy (SPL) over conventional laparoscopy by measuring prospectively the morbidity specifically related to conventional trocar sites (TS).
From November 2010 to December 2011, 300 patients undergoing various laparoscopic procedures were enrolled. Patient, surgery, and trocar characteristics were recorded. We evaluated at three time points (in-hospital and at 1 and 6 months postoperatively) specifically for each TS, pain (Visual Analog Scale), morbidity (infection, hematoma, hernia), and cosmesis (Patient Scar Assessment Score; PSAS). Patients designated their "worst TS," and a composite endpoint "bad TS" was defined to include any adverse outcome at a TS.
We analyzed 1,074 TS. Follow-up was >90 %. Pain scores of >3/10 at 1 and 6 months postoperatively, were reported by 3 and 1 % of patients at the 5 mm TS and by 9 and 1 % at the larger TS, respectively (5 mm TS vs larger TS; p = 0.001). Pain was significantly lower for TS located in the lower abdomen than for the upper abdomen or the umbilicus (p = 0.001). The overall complication rate was <1 % and significantly lower for the 5 mm TS (hematoma p = 0.046; infection p = 0.0001). No hernia was found. The overall PSAS score was low and significantly lower for the 5 mm TS (p = 0.0001). Significant predictors of "bad TS" were larger TS (p = 0.001), umbilical position (p = 0.0001), emergency surgery (p = 0.0001), accidental trocar exit (p = 0.022), fascia closure (p = 0.006), and specimen extraction site (p = 0.0001).
Specific trocar morbidity is low and almost negligible for 5 mm trocars. The umbilicus appears to be an unfavorable TS.
Keywords
Abdomen/surgery, Cicatrix/etiology, Cicatrix/psychology, Elective Surgical Procedures/adverse effects, Emergencies, Fasciotomy, Follow-Up Studies, Hematoma/etiology, Humans, Laparoscopy/adverse effects, Laparoscopy/instrumentation, Laparoscopy/methods, Pain Measurement, Pain, Postoperative/etiology, Patient Satisfaction, Prospective Studies, Surgical Wound Infection/etiology, Umbilicus, Wound Closure Techniques/adverse effects
Pubmed
Web of science
Create date
18/12/2014 18:29
Last modification date
09/09/2021 6:14
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