Cut-and-screw insertion: a method for safe and speedy secondary trocar insertion in laparoscopic surgery.

Laparoscopic surgery is increasingly applied to the treatment of gastrointestinal disease. However, the insertion of secondary trocars following pneumoperitoneum carries the risk of serious complications such as major vascular and bowel injuries. Such injury can arise when the force required for the trocar insertion is such that it causes the operator to have impaired control over the entry. There is a need for a procedure of secondary trocar insertion that is safe and easy to perform for training clinicians in laparoscopic surgery. We have developed the "cut-and-screw" insertion method for secondary trocar insertion using a specially developed laparoscopic cannula with a sharp edge and housing. Our procedure is simple, rapid, and safe. In this chapter, we describe the technique and present our initial clinical results.