Trocars in minimally invasive surgery: Costs and benefits

Nowadays, a variety of different trocar types are available, differing in diameter, material, reusability, and cost. The purpose of our study was to investigate the cost-benefit analysis of trocar types which are used in our hospital. A total of 2947 patients underwent laparoscopic surgery since January 1991. The study design was a retrospective data collection. Only paraumbilically inserted 10-12 mm trocary were included in this study. In group 1 (n = 1567) a resterilisable 10-mm trocar was used, in group 2 (n = 1365) a 10-mm or 12-mm single-use trocar. The rate of previously performed abdominal surgery was identical for both groups (4.8%). Trocar-related complications occurred in three patients of group 1 (0.2%, two bowel injuries). Although the costs of resterilisable trocars are four times higher than those of single-use trocars, the economy of resterilisable trocars clearly appears by frequent use. The forensic aspect of the ''safety mechanism'' in single-use trocars remains unknown. However, the ''safety mechanism'' may fail in the case of an extremely obese abdominal wail, or severe adhesions. Therefore, we perform a mini-laparotomy prior to trocar placement to minimize the risk of trocarrelated complications.