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your annual OSHA sharps safety assessment, however).
• Bladeless trocars may not have blades, but they're still pointed so surgeons can essentially screw them in through the fascia, which reduces the chance of adhesions. These models also come in optical versions — transparent devices, so surgeons can better visualize the trocars' tips as they slide into the abdomen.
• Dilating tip trocars spread or dilate the fascia, rather than actually slicing through it, which decreases adhesion risk. These are also available in optical versions.
• Blunt trocars are literally dull at the end and, instead of being suited for parting fascial tissue, they're used when surgeons want to convert from laparotomy to laparoscopy.
Is any single port safer than another? A recent review of 28 randomized controlled trials involving nearly 5,000 patients undergoing laparoscopy compared entry techniques. According to the findings published in the Feb. 2012 Cochrane Database of Systematic Reviews (tinyurl.com/bkzoh3u), direct-trocar entry (without pre-insufflation) was advantageous compared to Veress needle (insufflations to create pneumoperitoneum) in that there were lower rates of failed entry, extraperitoneal insufflations and omental injury. Other findings: Dilating tip trocars showed reduced port-site bleeding compared with standard bladed trocars; and no advantage was seen in terms of failed entry rates from lifting or not lifting the abdominal wall before Veress needle insertion.
Overall, the review's authors say there was no evidence that a single
