Randomized double-masked comparison of radially expanding access device and conventional cutting tip trocar in laparoscopy

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. (C) 2001 by The American College of Obstetricians and Gynecologists.