Surgeon's Guide to the Safe Use of Shielded Trocars



Poster

Not all shielded trocars are alike. Shielding methods vary among models, and the methods of insertion differ from those used for nonshielded trocars. Heed the supplier's instructions, cautions, and contraindications. In addition, surgeons should take the following precautions when using shielded trocars for minimally invasive surgery (MIS):

Before Use

  • Be intimately familiar with your equipment.
  • Be aware of the risks of trocar use (such as vascular injury).
  • Identify patients at greater risk of trocar injury (for example, thin patients, patients who have had prior abdominal surgeries) and consider alternative methods of abdominal entry (such as open laparotomy).
  • Ensure that the patient is positioned (for example, placed in the Trendelenburg position) so that organs and other important structures are not directly in the trocars' intended path.
  • Ensure that a vascular surgeon or a general surgeon familiar with MIS injuries is immediately available to address major vessel repairs.

During Insertion

  • Ensure that the incision is large enough to accommodate the trocar shield.
  • Do not allow anyone but you to arm the trocar; do not arm the trocar until just before insertion.
  • Insert the trocar slowly, steadily, and at the correct angle. Do not twist the trocar unless the tip is free to rotate.
  • Avoid gripping the trocar too tightly, placing heavy finger pressure on the shaft of the cannula, or touching the shield indicator or arming button during insertion.
  • Do not rely on a tip shield to prevent injury.
  • If unusual resistance is felt during insertion, stop pushing, withdraw the trocar, and remove it from service.
  • Be aware that loss of blood pressure may signal vascular injury.
  • Be aware that reinserting an armed shielded trocar through an open trocar hole may cause failure of the shield.
  • Save suspect trocars for later inspection; do not inspect such devices during surgery.


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