Dilating missile trocar for primary port establishment: a cadaver study.

The missile trocar was developed for controllable entry force, smaller fascial defects and post-operative pain improvement. The trocar was composed of a fascial-dilating long-conical head and a handle. Accompanied with this trocar, the authors designed a rectus sheath-hooking instrument to promote negative intra-abdominal pressure during the trocar puncture. The hooking procedure allowed room air to pass through the central canal of the trocar and fill the space between the intestinal loops and the trocar tip. The abdominal access procedure succeeded in forty-five attempts in fresh cadavers. No second attempt was done. The trocar accessed into the peritoneal cavity at every attempt without intestinal penetration. The missile trocar may be an alternative device for establishment of the primary port. Its efficacy and safety still has to be proved.

Rectus sheath hooking: alternative method of abdominal wall lifting and fixing for laparoscopy: a pilot cadaver bio-mechanical study.

Four bio-mechanical tests were used to study properties of the rectus sheath for laparoscopic abdominal access procedure and to provide surgical exposure by the ChulaLift gasless retractor. The profile of forces and displacement showed how some patients were good candidates for the gasless operation. The lifting weight should not excess 10 kg for minimal harm and optimal exposure. The rectus hooking could be an alternative choice for abdominal wall fixing during the first trocar entry. One-cm width hooking, the rectus sheath could withstand 18-20 kg lifting force. The exposure provided by the gasless technique was narrow between the lateral ports compared to the conventional technique. The rectus sheath could be hooked to provide effective fixing of the area to be penetrated by the first trocar, and this fascial layer could be lifted to produce exposure in the gasless technique.