The Safety and Complications of “Z-entry” Technique of Trocar Insertion in Laparoscopic Gynecological Surgery

Abstract

Background and Aims: Laparoscopy is a minimally invasive surgical technique for abdominal and gynecological surgeries. To access the internal organs through the abdominal wall, a special tool called a trocar is used. The trocar enters the abdomen using a variety of techniques. The aim of this study was to evaluate the safety and possible complications of trocar insertion into the abdomen for gynecological laparoscopy using the "Z-entry" method. Methods: From March 2018 to March 2020, 435 patients underwent laparoscopic gynecological surgery in Sarem specialized hospital. The consequences of trocar entering the abdomen with the "Z-entry" technique, including visceral injury, vascular injury, umbilical hernia, hematoma, massive hemorrhage, infection, and mortality induced by trocar insertion, were evaluated. The results were analyzed and reported in the form of descriptive statistics and frequency distribution tables with SPSS statistical software. Findings: This study showed that the rate of complications and problems due to insertion of trocar by "Z-entry" method was very low in these patients. They were comprised of one case of infection (0.2%), one case of hematoma (0.2%), one case of trocar entry into blood vessels (0.2 %) and two cases (0.4%) of trocar entry into the viscera. However, no case of umbilical hernia, massive hemorrhage, and death induced by trocar insertion was found. Conclusion: Insertion of trocar by the "Z-entry" method in laparoscopic gynecological surgeries is associated with minimal problems and complications and therefore this technique can be used as a safe method to insert trocar into the abdomen in laparoscopic surgeries.