Hassan trocar for laparoscopy - Forum

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Biliary surgeon

Hassan trocar for laparoscopy - Ärzteforum

Post#1 »

Why is there some reluctance to adopt Hassan's trochar as the gold standard for operative laparoscopy? The inherent safety, particularly in the previously operated abdomen, should more than justify a short learning curve (2 or 3 cases) to get the hang of this technique. After quickly becoming familiar it, there is NO loss of time comparted to Verres needle and closed sharp trochar entry. In my community Hospital we have had 2 colonoscopies done transabdominally through the laparoscope in the last 5 years, one during lap chole with sharp trochar, another during gyn prodedure with sharp trochar.


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الجراح

Re: Hassan trocar for laparoscopy - Ärzteforum

Post#2 »

Please,don't mistake Hassan's trocar with id's technique to approach laparoscopically an operated abdomen.As I said, perform a very small umbilical incision,get into the peritoneal cavity and place your trocar (port) freely inside it, pretending to insufflate the cavity and not to perform an "endoluminal transparietal colonoscopy",thing that might happen if you work blindly and with any positive beneficit in the sense of viewing inside the colon.I'm sure that the pt. won't appreciate such action. "Ca me semble un peu stupid, un peu ironique et pas du tout pratique".If you are not able to try it with good results,please call someone who can do it.

Grandpa Phil

Re: Hassan trocar for laparoscopy - Ärzteforum

Post#3 »

I did my first lap chole in Aug, 1990. I have never used any other technique, nor have I ever injured the bowel as I've entered the abdomen. It is the only approach in the patient, who has had previous abdominal operations.

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Lady Surgeon

Re: Hassan trocar for laparoscopy - Ärzteforum

Post#4 »

I saw a trocar go through the aorta (or rather, I helped run the code when I heard the screams from the room next door) and thus have always used the Hassan technique.

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Old surgeon

Re: Hassan trocar for laparoscopy - Ärzteforum

Post#5 »

At the RACS meeting in May one of the many good tips from the Fielding / Nathanson team of surgeons was for Hassan, as follows:

Pick up the deepest part of the umbilicus with Rutherford-Morrison forceps and this will evert it. Incise with an 11 blade, and you are right through the linea alba and onto the peritoneum, not floppy here, tethered under the tough fascia. You are generally in in about a quarter of a minute [somehow it takes me longer - also I may pick up each edge of fascia in a haemostat].

Poland

Re: Hassan trocar for laparoscopy - Ärzteforum

Post#6 »

What is the HASSAN trocar?

Many thanks for your explanation.

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Loit

Re: Hassan trocar for laparoscopy - Ärzteforum

Post#7 »

It is a blunt trocar for the umbilical port developed by Dr. Hasson. It has suture attachments so you can place a suture on either side of the umbilical fascia, then wrap it around the suture attachments to maintain your pneumoperitoneum. Ethicon and AutoSuture make disposable versions. You can buy the reusable version from Snowden-Pencer and probably other companies. At the end of the case, you tie the sutures together to close the umbilical fascia site.

Avicenna

Re: Hassan trocar for laparoscopy - Ärzteforum

Post#8 »

How I do the Hassan technique:

I make an incision as deeply as conveniently possible, then place the Hassan S retractors to expose deeper. When I see the fascia, I make an incision in it. I then Poke through the peritoneum at the umbilicus with my finger (fastest technique and it is almost always weak just below umbilicus).

I then place my sutures on either side of the fascia, usually as half purse string sutures (like you would use if you placed a pursestring suture around a bowel end to use the EEA type automatic stapler).

I then place the blunt trocar and wind the sutures around the suture wings. The new versions, of course, have adjustable olives (wide sleeves that help maintain the pneumoperitoneum) so you can slide the trocar up and down inside the olive without resetting the sutures (the original versions could not be moved in and out without removing and reattaching the sutures, which was a nuisance.

I always bring the gallbladder out my subxiphoid port, because it is quickest.

I have only once injured the small bowel with the open technique in a reasonably muscular young man (but this was before I started using the above technique)---I made the skin and subcu incision, placed sutures in the fascia (old technique) and cut throught between the sutures and found I had caught a loop of small bowel in the fascial sutures. I pulled the loop of small bowel up through the umbilical port incision, put a few sutures in it and completed a lap appy. I tried to keep him NPO and in the hospital, but he insisted on eating that evening and wanted to go home the next day (I did of course tell him what had happened). He did fine. The message here is that you can repair these injuries easily.

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Treatment guru

Re: Hassan trocar for laparoscopy - Ärzteforum

Post#9 »

The Hasson device is a sleeve with a blunt obturator and a cone around it with two ears. It is not a trocar. It is inserted via a small 10-15 mm incision. My technique is as follows 15 mm vertical incision just above the umbilicus. Dissect bluntly to the fascia. Grab fascia with two Kocher clamps, using a couple of army-navy retractors to facilitate vision. Incise fascia between clamps, and insert a 0-Dexon stitce on either side. release the clamps, pull the fascia apart with the stitches, and enter peritoneal cavitiy with finger. Insert Hasson Cannula (we use a disposable one from autosuture) lock in place by looping stitches around ears. Do lap.

Pediatric surg

Re: Hassan trocar for laparoscopy - Ärzteforum

Post#10 »

In children most complications are due to the Verres needle. We advocate for Hassan's trochar, that's the way we do it and recommend it.

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