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Randomized Double-masked Comparison of Radially Expanding Access Device and Conventional Cutting Tip Trocar in Laparoscopy

From the Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China.

Address reprint requests to: So Fan Yim, MBChB, MRCOG, Department of Obstetrics and Gynecology, Prince of Wales Hospital, Hong Kong, SAR, China, E-mail: sfyim{at}cuhk.edu.hk

Objective: To compare postoperative wound pain associated with the radially expanding access device and the conventional disposable cutting-tip trocar.

Methods: Our randomized, double-masked, self-controlled study involved 34 women scheduled for laparoscopic adnexal surgery. In each, a 10-mm radially expanding access device was inserted laterally on one side of the lower abdomen and a size-matched disposable cutting-tip trocar was placed on the other side, using random assignment. Postoperative pain for each studied wound and patient satisfaction toward the wounds were assessed using a visual analog scale. Any bleeding complication associated with insertion of the trocar was also recorded.

Results: The radially expanding access device was associated with significant reduction in severity (median 1.4 versus 5.0, P < .001) and duration (median 11 versus 21 days, P < .001) of postoperative wound pain, shorter wound scars (14 versus 17 mm, P < .001), a lower incidence of wound induration (0 versus 9, P < .01), and a higher patient satisfaction (median 9.7 versus 6.2, P < .001). There were four inferior epigastric artery injuries, all at the conventional trocar wound.

Conclusion: The radially expanding access device was associated with less postoperative wound pain and more patient satisfaction than the conventional cutting-tip trocar.

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