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Trocar sites are the small entry sites made though abdomen for the entry of surgical instruments. After a small incision is made in the skin, the trocar is the instrument inserted to penetrate the abdominal wall. Trocars of different sizes can create entry sites ranging from 5 to 20mm in diameter. The diameter size depends on whether the removal of a specimen is anticipated and its size (e.g. 15 or 20mm would likely be necessary for the removal of something as large and solid as a uterus). There are usually three trocar sites (see diagram 3).  The one at the umbilicus (the "belly button") is termed the primary trocar (usually 10mm). It is inserted at a 45° angle from horizontal (to avoid the aortic bifurcation) (in obese patients, the angle can be safely increased). The primary trocar site (after creating a pneumoperitoneum) is where the laparoscope will be inserted into the abdomen. The laparoscope can then be used to observe the inside of the abdomen as the other (secondary) trocar sites (usually 5mm) are penetrating through. This is to ensure no major blood vessel is hit or other inadvertent injury happens. The secondary sites are often above the pubic hair line. |