Clinical Experience with an Optical Access Trocar in Gynecological Laparoscopy-Pelviscopy

BACKGROUND AND OBJECTIVES Development in surgical technology must demand not only improved efficacy and risk reduction but also a reduction in costs and efficient use of human resources. For 25 years we have discussed the development of optical access trocars and their probable benefits. They are now available in the form of the OPTIVIEW by Ethicon and the SURGIVIEW by US Surgical. METHODS Between December 1996 and March 1997, we utilized the optic obturator trocar, OPTIVIEW, in 104 cases of gynecological operative laparoscopy. The instrument was equipped with an axial grip to facilitate ergonomic handling. RESULTS The optical trocar was used with a Z-incision techniques in 16 cases; a vertical incision was used in 58 cases. In all of the gynecological procedures, the optical trocar was more advantageous than classic trocars placed without direct vision. Our estimation was that separation of tissue layers was very good in 71 cases, good in 26 cases and problematic in 5 cases. No complications occurred with the use of this trocar. The Z-incision was preferable to the vertical incision although it required a longer time of insertion of up to 5 seconds. Altogether, the OPTIVIEW presented an easy way of avoiding intestinal and vascular injury during initial trocar entry. CONCLUSIONS The application of this new tool is practical, safe and handy. However, it requires training in its appropriate use. Vertical incisions should be sutured after removal of the instrument. Additional trocars need not be optical trocars as they can be placed under direct vision and laparoscopic control. It is our opinion that a combination of sophisticated new technologies such as the OPTIVIEW trocar, robotic arm, harmonic scalpel and 3-D vision would provide safe and efficient means to accomplish gynecologic laparoscopic surgical procedures.