Trocar

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Disposable trocar family Disposable Trocars.jpg
Disposable trocar family

A trocar (or trochar) is a medical or veterinary device that is made up of an obturator (which may be a metal or plastic sharpened or non-bladed tip), a cannula (basically a hollow tube), and a seal. Trocars are placed through the abdomen during laparoscopic surgery. The trocar functions as a portal for the subsequent placement of other instruments, such as graspers, scissors, staplers, etc. Trocars also allow the escape of gas or fluid from organs within the body.

Medical device Equipment designed to aid in the diagnosis, monitoring or treatment of medical conditions

A medical device is any device intended to be used for medical purposes. Thus what differentiates a medical device from an everyday device is its intended use. Medical devices benefit patients by helping health care providers diagnose and treat patients and helping patients overcome sickness or disease, improving their quality of life. Significant potential for hazards are inherent when using a device for medical purposes and thus medical devices must be proved safe and effective with reasonable assurance before regulating governments allow marketing of the device in their country. As a general rule, as the associated risk of the device increases the amount of testing required to establish safety and efficacy also increases. Further, as associated risk increases the potential benefit to the patient must also increase.

Veterinary medicine deals with the diseases of animals, animal welfare, etc.

Veterinary medicine is the branch of medicine that deals with the prevention, diagnosis and treatment of disease, disorder and injury in animals. The scope of veterinary medicine is wide, covering all animal species, both domesticated and wild, with a wide range of conditions which can affect different species.

Cannula

A cannula is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of samples. In simple terms, a cannula can surround the inner or outer surfaces of a trocar needle thus extending the effective needle length by at least half the length of the original needle. It is also called an intravenous (IV) cannula. Its size mainly ranges from 14 to 24 gauge. Different-sized cannula have different colours as coded.

Contents

Etymology

The word trocar, less commonly trochar, [1] comes from French trocart, trois-quarts (three-fourths), from trois 'three' and carre 'side, face of an instrument', [2] [3] first recorded in the Dictionnaire des Arts et des Sciences, 1694, [4] by Thomas Corneille, younger brother of Pierre Corneille.

French language Romance language

French is a Romance language of the Indo-European family. It descended from the Vulgar Latin of the Roman Empire, as did all Romance languages. French evolved from Gallo-Romance, the spoken Latin in Gaul, and more specifically in Northern Gaul. Its closest relatives are the other langues d'oïl—languages historically spoken in northern France and in southern Belgium, which French (Francien) has largely supplanted. French was also influenced by native Celtic languages of Northern Roman Gaul like Gallia Belgica and by the (Germanic) Frankish language of the post-Roman Frankish invaders. Today, owing to France's past overseas expansion, there are numerous French-based creole languages, most notably Haitian Creole. A French-speaking person or nation may be referred to as Francophone in both English and French.

Thomas Corneille French dramatist

Thomas Corneille was a French dramatist.

Pierre Corneille French tragedian

Pierre Corneille was a French tragedian. He is generally considered one of the three great seventeenth-century French dramatists, along with Molière and Racine.

History

Trocar, c. 1850. Hamburg Museum 2011-2255.jpg
Trocar, c. 1850.

Originally, doctors used trocars to relieve pressure build-up of fluids (edema) or gases (bloating). Patents for trocars appeared early in the 19th century, although their use dated back possibly thousands of years. By the middle of the 19th century, trocar-cannulas had become sophisticated, such as Reginald Southey's invention of the Southey tube. [5]

Edema abnormal accumulation of fluid in the interstitium

Edema, also spelled oedema or œdema, is an abnormal accumulation of fluid in the interstitium, located beneath the skin and in the cavities of the body, which can cause severe pain. Clinically, hyperaldosteronism, edema manifests as swelling. The amount of interstitial fluid is determined by the balance of fluid homeostasis and the increased secretion of fluid into the interstitium. The word is from Greek οἴδημα oídēma meaning "swelling". The condition is also known as dropsy.

Abdominal bloating is a symptom that can appear at any age, generally associated with functional gastrointestinal disorders or organic diseases, but can also appear alone. The person feels a full and tight abdomen. Although this term is usually used interchangeably with abdominal distension, these symptoms probably have different pathophysiological processes, which are not fully understood.

Reginald Southey British doctor

Reginald Southey was an English physician and inventor of Southey's cannula or tube, a type of trocar used for draining oedema of the limbs.

Applications

Medical/surgical use

Trocars are used in medicine to access and drain collections of fluid such as in a patient with hydrothorax or ascites.

Hydrothorax pleural effusion containing serous liquid

Hydrothorax is a type of pleural effusion in which transudate accumulates in the pleural cavity. This condition is most likely to develop secondary to congestive heart failure, following an increase in hydrostatic pressure within the lungs. More rarely, hydrothorax can develop in 10% of patients with ascites which is called hepatic hydrothorax. It is often difficult to manage in end-stage liver failure and often fails to respond to therapy.

Ascites Abnormal buildup of fluid in the abdomen

Ascites is the abnormal buildup of fluid in the abdomen. Technically, it is more than 25 ml of fluid in the peritoneal cavity. Symptoms may include increased abdominal size, increased weight, abdominal discomfort, and shortness of breath. Complications can include spontaneous bacterial peritonitis.

In modern times, surgical trocars are used to perform laparoscopic (keyhole) surgery. They are deployed as a means of introduction for cameras and laparoscopic hand instruments, such as scissors, graspers, etc., to perform surgery hitherto carried out by making a large abdominal incision ("open" surgery), something that has revolutionized patient care. Today, surgical trocars are most commonly a single patient use instrument and have graduated from the "three-point" design that gave them their name to either a flat bladed "dilating-tip" product or something that is entirely blade free. This latter design offers greater patient safety due to the technique used to insert them.

Trocar insertion can lead to a perforating puncture wound of an underlying organ resulting in a medical complication. Thus, for instance, a laparoscopic intra-abdominal trocar insertion can lead to bowel injury leading to peritonitis or injury to large blood vessels with hemorrhage. [6]

Embalming

Trocars are also used near the end of the embalming process to provide drainage of bodily fluids and organs after the vascular replacement of blood with embalming chemicals. Rather than a round tube being inserted, the three sided knife of the classic trocar would split the outer skin into three "wings" which was then easily sutured closed in a less obtrusive way. It is attached to a suction hose (which usually is attached to a water aspirator). The process of removing gas, fluids, and semi-solids from the body cavities and hollow organs using the trocar is known as aspiration. The instrument is inserted into the body two inches to the left and two inches up from the navel. After the thoracic, abdominal, and pelvic cavities have been aspirated, the embalmer injects cavity fluid into the thoracic, abdominal and pelvic cavities using a smaller trocar attached via a hose which is connected to a bottle of high index cavity fluid. The bottle is held upside down in the air so as to let gravity take the cavity fluid through the trocar and into the cavities. The embalmer moves the trocar in the same manner used when aspirating the cavities in order to fully and evenly distribute the chemical.

Embalming Method of preserving human remains

Embalming is the art and science of preserving human or animal remains by treating them to forestall decomposition. The intention is usually to make the deceased suitable for public or private viewing as part of the funeral ceremony, or keep them preserved for medical purposes in an anatomical laboratory. The three goals of embalming are sanitization, presentation, and preservation, with restoration being an important additional factor in some instances. Performed successfully, embalming can help preserve the body for a duration of many years. Embalming has a very long and cross-cultural history, with many cultures giving the embalming processes a greater religious meaning.

Thoracic cavity

The thoracic cavity is the chamber of the body of vertebrates that is protected by the thoracic wall. The central compartment of the thoracic cavity is the mediastinum. There are two openings of the thoracic cavity, a superior thoracic aperture known as the thoracic inlet and a lower inferior thoracic aperture known as the thoracic outlet.

Abdominal cavity body cavity in the abdominal area

The abdominal cavity is a large body cavity in humans and many other animals that contains many organs. It is a part of the abdominopelvic cavity. It is located below the thoracic cavity, and above the pelvic cavity. Its dome-shaped roof is the thoracic diaphragm, a thin sheet of muscle under the lungs, and its floor is the pelvic inlet, opening into the pelvis.

After cavity embalming has been finished, the puncture is commonly sealed using a small, plastic object resembling a screw, called a trocar button.

Veterinary use

Trocars are widely used by veterinarians not only for draining hydrothorax, ascites, or for introducing instruments in laparoscopic surgery, but for acute animal-specific conditions as well. In cases of ruminal tympany (bloat) in cattle, a wide-bore trocar may be passed through the skin into the rumen to release trapped gas. [7] In dogs, a similar procedure is often performed for patients presenting with GDV (gastric dilatation-volvulus) in which a wide-bore trocar is passed through the skin into the stomach to immediately decompress the stomach. Depending on the severity of clinical signs on presentation, this is often performed after pain management has been administered but prior to general anaesthesia. Definitive surgical treatment involves anatomical repositioning of the stomach and spleen followed by a right-sided gastropexy. [8] Depending on the severity, partial gastrectomy and/or splenectomy may be indicated if the relevant tissues have necrosed due to ischemia caused by torsion/avulsion of the supplying vasculature. 72-hour post-operative supportive care, fluid therapy and ECG monitoring for cardiac arrhythmias is highly recommended.

Notes

  1. "trocar". Merriam-Webster Dictionary. Merriam-Webster. Retrieved December 6, 2018.
  2. "trocar". Oxford Dictionaries. Oxford University Press. Retrieved December 6, 2018.
  3. Kucklick, Theodore R. (2013). The Medical Device R&D Handbook (2 ed.). Boca Raton, FL: CRC Press, Taylor & Francis Group. p. 109. Retrieved December 6, 2018.
  4. Dictionnaire des Arts et des Sciences, de Thomas Corneille (1694, 1720, 1732)
  5. Library, Boston Medical (20 February 2018). "Boston Medical Library". www.countway.harvard.edu.
  6. S. Krishnakumar; P. Taube. "Entry Complications in Laparoscopic Surgery". J Gynecol Endosc Surg. 1: 4–11. doi:10.4103/0974-1216.51902. PMC   3304260 . PMID   22442503.
  7. Constable, PD; Hinchcliff, KW; Done, SH; Gruenberg, W (2016). "Chapter 8: Diseases of the alimentary tract - ruminants. Ruminal tympany (bloat)". Veterinary Medicine: A textbook of the diseases of cattle, horses, sheep, pigs and goats (11 ed.). Elsevier Health Sciences. pp. 473–482. ISBN   9780702070587.
  8. Bright, Ronald M. (June 2007). "Acute Gastric Dilatation-Volvulus in Dogs" (PDF). Clinician's Brief.

Related Research Articles

The term abdominal surgery broadly covers surgical procedures that involve opening the abdomen (laparotomy). Surgery of each abdominal organ is dealt with separately in connection with the description of that organ Diseases affecting the abdominal cavity are dealt with generally under their own names.

Laparoscopy procedure in which a laparoscope is inserted through a small incision near the navel to examine abdominal and pelvic organs

Laparoscopy invented by George Kelling in 1901, in Germany, is an operation performed in the abdomen or pelvis using small incisions with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.

Hernia abnormal exit of tissue or an organ through the wall of the cavity in which it normally resides

A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Hernias come in a number of types. Most commonly they involve the abdomen, specifically the groin. Groin hernias are most common of the inguinal type but may also be femoral. Other hernias include hiatus, incisional, and umbilical hernias. Symptoms are present in about 66% of people with groin hernias. This may include pain or discomfort especially with coughing, exercise, or going to the bathroom. Often it gets worse throughout the day and improves when lying down. A bulging area may occur that becomes larger when bearing down. Groin hernias occur more often on the right than left side. The main concern is strangulation, where the blood supply to part of the bowel is blocked. This usually produces severe pain and tenderness of the area. Hiatus or hiatal hernias often result in heartburn but may also cause chest pain or pain with eating.

Peritonitis inflammation of the peritoneum, the lining of the inner wall of the abdomen

Peritonitis is inflammation of the peritoneum, the lining of the inner wall of the abdomen and cover of the abdominal organs. Symptoms may include severe pain, swelling of the abdomen, fever, or weight loss. One part or the entire abdomen may be tender. Complications may include shock and acute respiratory distress syndrome.

Gastric dilatation volvulus A medical condition in dogs

Gastric dilatation volvulus (GDV), also known as gastric dilation, twisted stomach, or gastric torsion, is a medical condition that affects dogs in which the stomach becomes overstretched and rotated by excessive gas content. The word bloat is often used as a general term to mean gas distension without stomach torsion, or to refer to GDV.

Nissen fundoplication

A Nissen fundoplication, or laparoscopic Nissen fundoplication when performed via laparoscopic surgery, is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatal hernia. In GERD, it is usually performed when medical therapy has failed; but, with a Type II (paraesophageal) hiatus hernia, it is the first-line procedure. The Nissen fundoplication is total (360°), but partial fundoplications known as Thal, Belsey, Dor, Lind, and Toupet fundoplications are alternative procedures with somewhat different indications and outcomes.

Percutaneous endoscopic gastrostomy type of gastrostomy in which a tube is passed into the stomach through the abdominal wall

Percutaneous endoscopic gastrostomy (PEG) is an endoscopic medical procedure in which a tube is passed into a patient's stomach through the abdominal wall, most commonly to provide a means of feeding when oral intake is not adequate. This provides enteral nutrition despite bypassing the mouth; enteral nutrition is generally preferable to parenteral nutrition. The PEG procedure is an alternative to open surgical gastrostomy insertion, and does not require a general anesthetic; mild sedation is typically used. PEG tubes may also be extended into the small intestine by passing a jejunal extension tube through the PEG tube and into the jejunum via the pylorus.

Surgical instrument Tools designed for use during surgery

A surgical instrument is a specially designed tool or device for performing specific actions or carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access for viewing it. Over time, many different kinds of surgical instruments and tools have been invented. Some surgical instruments are designed for general use in surgery, while others are designed for a specific procedure or surgery. Accordingly, the nomenclature of surgical instruments follows certain patterns, such as a description of the action it performs, the name of its inventor(s), or a compound scientific name related to the kind of surgery.

Volvulus Human disease

A volvulus is when a loop of intestine twists around itself and the mesentery that supports it, resulting in a bowel obstruction. Symptoms include abdominal pain, abdominal bloating, vomiting, constipation, and bloody stool. Onset of symptoms may be rapid or more gradual. The mesentery may become so tightly twisted that blood flow to part of the intestine is cut off, resulting in ischemic bowel. In this situation there may be fever or significant pain when the abdomen is touched.

Gastrointestinal perforation perforation in the wall of part of the gastrointestinal tract.

Gastrointestinal perforation, also known as ruptured bowel, is a hole in the wall of part of the gastrointestinal tract. The gastrointestinal tract includes the esophagus, stomach, small intestine, and large intestine. Symptoms include severe abdominal pain and tenderness. When the hole is in the stomach or early part of the small intestine the onset of pain is typically sudden while with a hole in the large intestine onset may be more gradual. The pain is usually constant in nature. Sepsis, with an increased heart rate, increased breathing rate, fever, and confusion may occur.

Laparoscopic hiatal hernia repair

Laparoscopic hernia repair is the repair of a hiatal hernia using a laparoscope, which is a tiny telescope-like instrument. A hiatal hernia is the protrusion of an organ through its wall or cavity. There are several different methods that can be used when performing this procedure. Among them are the Nissen Fundoplication and the general laparoscopic hernia repair.

Veterinary surgery

Veterinary surgery is surgery performed on animals by veterinarians, whereby the procedures fall into three broad categories: orthopaedics, soft tissue surgery, and neurosurgery. Advanced surgical procedures such as joint replacement, fracture repair, stabilization of cranial cruciate ligament deficiency, oncologic (cancer) surgery, herniated disc treatment, complicated gastrointestinal or urogenital procedures, kidney transplant, skin grafts, complicated wound management, minimally invasive procedures are performed by veterinary surgeons. Most general practice veterinarians perform routine surgery [neuters, minor mass excisions, etc.], some also perform additional procedures.

Gastric volvulus or volvulus of stomach is a twisting of all or part of the stomach by more than 180 degrees with obstruction of the flow of material through the stomach, variable loss of blood supply and possible tissue death. The twisting can occur around the long axis of the stomach: this is called organoaxial or around the axis perpendicular to this, called mesenteroaxial. Obstruction is more likely in organoaxial twisting than with mesenteroaxial while the latter is more associated with ischemia. About one third of the cases are associated with a hiatus hernia. Treatment is surgical.

"Tubal Reversal," also called "Tubal Sterilization Reversal," or "Tubal Ligation Reversal," or "Microsurgical Tubal Reanastomosis," is a surgical procedure that can restore fertility to women after a tubal ligation. By rejoining the separated segments of the fallopian tube, tubal reversal can give women the chance to become pregnant again. In some cases, however, the separated segments cannot actually be reattached to each other. In some cases the remaining segment of tube needs to be reimplanted into the uterus. In other cases, when the end of the tube has been removed, a procedure called a neofimbrioplasty must be performed to recreate a functional end of the tube which can then act like the missing fimbria and retrieve the egg that has been released during ovulation.

Canine gastropexy is a surgical procedure performed most commonly in large breed dogs to prevent gastric dilatation volvulus (GDV), commonly known as bloat. GDV is a life-threatening condition in which the stomach flips over and expands, trapping air and gases in the stomach. Circulation to the stomach and spleen is subsequently interrupted, resulting in shock which can be fatal.

A Veress needle or Veres needle is a spring-loaded needle used to create pneumoperitoneum for laparoscopic surgery. Of the three general approaches to laparoscopic access, the Veress needle technique is the oldest and most traditional.

Ruminal tympany, also known as bloat, is a disease of ruminant animals, characterized by an excessive volume of gas in the rumen. Ruminal tympany may be primary, known as frothy bloat, or secondary, known as free-gas bloat.

References