Trocar Injuries on the Increase

A study has shown that in the period from 1997 to mid-2002, the U.S. Food and Drug Administration (FDA, Washington, DC, USA) received more than 1,300 laparoscopic trocar injury reports, including reports of 30 or more deaths since then. The study was updated in June 2005 after originally being completed in November 2003.

"In order to perform a laparoscopic procedure, typically from 2-4 trocars, or access ports, are inserted into the abdominal cavity to allow entry of the required laparoscopic instruments. Insertion of these trocars carries a risk for life-threatening injury,” said FDA officials. "Hemorrhage due to vessel injury and infection secondary to bowel injury, especially when diagnosis is delayed, are the most serious complications and the most likely to result in death.

Most data suggest that the rate of trocar-related complications is less than 3%, according to the FDA investigators. Patient records in military facilities showed a 6% complication rate, while the average incidence of trocar-related vascular injuries is only about 0.1%. Bowel injuries occur more frequently, showing an average incidence of less than 1%. Overall, mortality rates were reported to be 0.1% or less.

"Injuries appear to occur most frequently during insertion of trocars into the abdomen or pelvis. Several studies suggest that the initial trocar insertion is the most dangerous aspect of trocar use, and possibly the most dangerous step in minimally invasive surgery,” according to FDA sources. A 1996 study found that 83% of vascular injuries, 75% of bowel injuries, and 50% of local hemorrhage injuries were caused during primary trocar insertion.

Other reported findings of the study were that major vessel injuries are usually the result of operator error, and that delayed awareness of injury in people over the age of 59 showed a significant association with a fatal outcome.