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Study flow diagram.
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Figure 1

Study flow diagram.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Forest plot of comparison: 1 Radially expanding trocar versus cutting trocar for primary and secondary port entry, outcome: 1.3 Trocar site herniation.
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Figure 4

Forest plot of comparison: 1 Radially expanding trocar versus cutting trocar for primary and secondary port entry, outcome: 1.3 Trocar site herniation.

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Forest plot of comparison: 1 Radially expanding trocar versus cutting trocar for primary and secondary port entry, outcome: 1.4 Trocar site bleeding.
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Figure 5

Forest plot of comparison: 1 Radially expanding trocar versus cutting trocar for primary and secondary port entry, outcome: 1.4 Trocar site bleeding.

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Forest plot of comparison: 1 Radially expanding trocar versus cutting trocar for primary and secondary port entry, outcome: 1.5 Trocar site haematoma.
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Figure 6

Forest plot of comparison: 1 Radially expanding trocar versus cutting trocar for primary and secondary port entry, outcome: 1.5 Trocar site haematoma.

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Forest plot of comparison: 2 Conical blunt‐tipped trocar versus cutting trocar for secondary port entry, outcome: 2.1 Visceral injury.
Figuras y tablas -
Figure 7

Forest plot of comparison: 2 Conical blunt‐tipped trocar versus cutting trocar for secondary port entry, outcome: 2.1 Visceral injury.

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Forest plot of comparison: 2 Conical blunt‐tipped trocar versus cutting trocar for secondary port entry, outcome: 2.2 Vascular injury.
Figuras y tablas -
Figure 8

Forest plot of comparison: 2 Conical blunt‐tipped trocar versus cutting trocar for secondary port entry, outcome: 2.2 Vascular injury.

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Forest plot of comparison: 2 Conical blunt‐tipped trocar versus cutting trocar for secondary port entry, outcome: 2.3 Trocar site herniation.
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Figure 9

Forest plot of comparison: 2 Conical blunt‐tipped trocar versus cutting trocar for secondary port entry, outcome: 2.3 Trocar site herniation.

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Forest plot of comparison: 3 Radially expanding trocar versus conical blunt‐tipped trocar for secondary port entry, outcome: 3.1 Visceral injury.
Figuras y tablas -
Figure 10

Forest plot of comparison: 3 Radially expanding trocar versus conical blunt‐tipped trocar for secondary port entry, outcome: 3.1 Visceral injury.

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Forest plot of comparison: 3 Radially expanding trocar versus conical blunt‐tipped trocar for secondary port entry, outcome: 3.2 Vascular injury.
Figuras y tablas -
Figure 11

Forest plot of comparison: 3 Radially expanding trocar versus conical blunt‐tipped trocar for secondary port entry, outcome: 3.2 Vascular injury.

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Forest plot of comparison: 4 Single‐bladed trocar versus pyramidal‐bladed trocar, outcome: 4.1 Visceral injury.
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Figure 12

Forest plot of comparison: 4 Single‐bladed trocar versus pyramidal‐bladed trocar, outcome: 4.1 Visceral injury.

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Forest plot of comparison: 4 Single‐bladed trocar versus pyramidal‐bladed trocar, outcome: 4.2 Vascular injury.
Figuras y tablas -
Figure 13

Forest plot of comparison: 4 Single‐bladed trocar versus pyramidal‐bladed trocar, outcome: 4.2 Vascular injury.

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Comparison 1 Radially expanding trocar versus cutting trocar for primary and secondary port entry, Outcome 1 Visceral injury.
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Analysis 1.1

Comparison 1 Radially expanding trocar versus cutting trocar for primary and secondary port entry, Outcome 1 Visceral injury.

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Comparison 1 Radially expanding trocar versus cutting trocar for primary and secondary port entry, Outcome 2 Vascular injury.
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Analysis 1.2

Comparison 1 Radially expanding trocar versus cutting trocar for primary and secondary port entry, Outcome 2 Vascular injury.

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Comparison 1 Radially expanding trocar versus cutting trocar for primary and secondary port entry, Outcome 3 Trocar site herniation.
Figuras y tablas -
Analysis 1.3

Comparison 1 Radially expanding trocar versus cutting trocar for primary and secondary port entry, Outcome 3 Trocar site herniation.

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Comparison 1 Radially expanding trocar versus cutting trocar for primary and secondary port entry, Outcome 4 Trocar site bleeding.
Figuras y tablas -
Analysis 1.4

Comparison 1 Radially expanding trocar versus cutting trocar for primary and secondary port entry, Outcome 4 Trocar site bleeding.

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Comparison 1 Radially expanding trocar versus cutting trocar for primary and secondary port entry, Outcome 5 Trocar site haematoma.
Figuras y tablas -
Analysis 1.5

Comparison 1 Radially expanding trocar versus cutting trocar for primary and secondary port entry, Outcome 5 Trocar site haematoma.

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Comparison 2 Conical blunt‐tipped trocar versus cutting trocar for secondary port entry, Outcome 1 Visceral injury.
Figuras y tablas -
Analysis 2.1

Comparison 2 Conical blunt‐tipped trocar versus cutting trocar for secondary port entry, Outcome 1 Visceral injury.

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Comparison 2 Conical blunt‐tipped trocar versus cutting trocar for secondary port entry, Outcome 2 Vascular injury.
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Analysis 2.2

Comparison 2 Conical blunt‐tipped trocar versus cutting trocar for secondary port entry, Outcome 2 Vascular injury.

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Comparison 2 Conical blunt‐tipped trocar versus cutting trocar for secondary port entry, Outcome 3 Trocar site herniation.
Figuras y tablas -
Analysis 2.3

Comparison 2 Conical blunt‐tipped trocar versus cutting trocar for secondary port entry, Outcome 3 Trocar site herniation.

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Comparison 2 Conical blunt‐tipped trocar versus cutting trocar for secondary port entry, Outcome 4 Trocar site bleeding, intraoperative.
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Analysis 2.4

Comparison 2 Conical blunt‐tipped trocar versus cutting trocar for secondary port entry, Outcome 4 Trocar site bleeding, intraoperative.

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Comparison 3 Radially expanding trocar versus conical blunt‐tipped trocar for secondary port entry, Outcome 1 Visceral injury.
Figuras y tablas -
Analysis 3.1

Comparison 3 Radially expanding trocar versus conical blunt‐tipped trocar for secondary port entry, Outcome 1 Visceral injury.

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Comparison 3 Radially expanding trocar versus conical blunt‐tipped trocar for secondary port entry, Outcome 2 Vascular injury.
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Analysis 3.2

Comparison 3 Radially expanding trocar versus conical blunt‐tipped trocar for secondary port entry, Outcome 2 Vascular injury.

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Comparison 4 Single‐bladed trocar versus pyramidal‐bladed trocar, Outcome 1 Visceral injury.
Figuras y tablas -
Analysis 4.1

Comparison 4 Single‐bladed trocar versus pyramidal‐bladed trocar, Outcome 1 Visceral injury.

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Comparison 4 Single‐bladed trocar versus pyramidal‐bladed trocar, Outcome 2 Vascular injury.
Figuras y tablas -
Analysis 4.2

Comparison 4 Single‐bladed trocar versus pyramidal‐bladed trocar, Outcome 2 Vascular injury.

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Summary of findings for the main comparison. Radially expanding trocars compared to cutting trocars for laparoscopy

Radially expanding trocars compared to cutting trocars for laparoscopy

Patient or population: people undergoing laparoscopy
Settings: surgical
Intervention: radially expanding trocars
Comparison: cutting trocars

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Cutting trocars

Radially expanding trocars

Visceral injury

4 per 1000

4 per 1000
(0 to 60)

OR 0.95
(0.06 to 15.32)

473
(4 studies)

⊕⊝⊝⊝
very low1,2

‐

Vascular injury

4 per 1000

1 per 1000
(0 to 28)

OR 0.14
(0.00 to 7.16)

473
(4 studies)

⊕⊝⊝⊝
very low1,2

‐

Trocar site herniation
Follow‐up: 6‐46 months

No events reported

No events reported

Not estimable3

463
(4 studies)

⊕⊝⊝⊝
very low2,4

‐

Trocar site bleeding

115 per 1000

35 per 1000
(18 to 66)

OR 0.28
(0.14 to 0.54)

553
(5 studies)

⊕⊝⊝⊝
very low2,4

‐

Trocar site haematoma5

See comment5

See comment5

Not estimable5

238
(2 studies)

⊕⊝⊝⊝
very low2,4

‐

Postoperative pain6

See comment6

See comment6

Not estimable6

306
(4 studies)

See comment6

‐

*The basis for the assumed risk is the mean control group risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; OR: odds ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Downgraded one level due to high risk of attrition bias.
2 Downgraded two levels due to imprecision: the number of events was fewer than 300 (the threshold rule‐of‐thumb value).
3 No events reported.
4 Downgraded one level due to risk of bias: in all included studies, high risk of performance bias, due to differences between groups for fascial closure or other types of port manipulation. Method of assessment mostly unclear.
5 Data could not be pooled because of clinical heterogeneity.
6 All studies provided insufficient statistical data, making it inappropriate to pool the data.

Figuras y tablas -
Summary of findings for the main comparison. Radially expanding trocars compared to cutting trocars for laparoscopy
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Summary of findings 2. Conical blunt‐tipped trocar compared to cutting trocar for laparoscopy

Conical blunt‐tipped trocar compared to cutting trocar for laparoscopy

Patient or population: people undergoing laparoscopy
Settings: surgical
Intervention: conical blunt‐tipped trocar
Comparison: cutting trocar

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Cutting trocar

Conical blunt‐tipped trocar

Visceral injury

No events reported

No events reported

Not estimable1

42
(1 study)

⊕⊝⊝⊝
very low2,3

‐

Vascular injury

No events reported

No events reported

Not estimable1

42
(1 study)

⊕⊝⊝⊝
very low2,3

‐

Trocar site bleeding

133 per 1000

20 per 1000
(2 to 246)

OR 0.13
(0.01 to 2.12)

30
(1 study)

⊕⊝⊝⊝
very low3,4

‐

Postoperative pain5

See comment5

See comment5

Not estimable5

42
(1 study)

⊕⊝⊝⊝
very low2,6,7

‐

*The basis for the assumed risk is the mean control group risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; OR: odds ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 No events reported.
2 Downgraded one level due to high risk of selection bias: unclear randomisation and allocation.
3 Downgraded two levels due to imprecision: the number of events was fewer than 300 (the threshold rule‐of‐thumb value).
4 Downgraded one level due to high risk of performance bias: personnel not blinded, unclear type and frequency of port manipulation.
5 Study provided insufficient statistical data, making it inappropriate to calculate adequate measures.
6 Downgraded one level due to risk of bias: attrition bias due lack of clarity on completeness of the outcome data and 'unit of analysis' issues and performance bias due to lack of clarity on degree and frequency of port manipulation.
7 Downgraded one level due to imprecision.

Figuras y tablas -
Summary of findings 2. Conical blunt‐tipped trocar compared to cutting trocar for laparoscopy
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Summary of findings 3. Radially expanding trocar compared to conical blunt‐tipped trocar for laparoscopy

Radially expanding trocar compared to conical blunt‐tipped trocar for laparoscopy

Patient or population: people undergoing laparoscopy
Settings: surgical
Intervention: radially expanding trocar
Comparison: conical blunt‐tipped trocar

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Conical blunt‐tipped trocar

Radially expanding trocar

Visceral injury

No events reported

No events reported

Not estimable1

28
(1 study)

⊕⊝⊝⊝
very low2,3

‐

Vascular injury

No events reported

No events reported

Not estimable1

28
(1 study)

⊕⊝⊝⊝
very low2,3

‐

Trocar site herniation

No events reported

No events reported

Not estimable1

28
(1 study)

⊕⊝⊝⊝
very low3,4

‐

*The basis for the assumed risk is the mean control group risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; OR: odds ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 No events reported.
2 Downgraded one level due to high risk of selection bias: unclear randomisation and allocation.
3 Downgraded two levels due to imprecision: Only 28 participants.
4 Downgraded one level due to risk of bias: attrition bias due to unclear loss to follow‐up and performance bias.

Figuras y tablas -
Summary of findings 3. Radially expanding trocar compared to conical blunt‐tipped trocar for laparoscopy
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Summary of findings 4. Single‐bladed trocar compared to pyramidal‐bladed trocar for laparoscopy

Single‐bladed trocar compared to pyramidal‐bladed trocar for laparoscopy

Patient or population: people undergoing laparoscopy
Settings: surgical
Intervention: single‐bladed trocar
Comparison: pyramidal‐bladed trocar

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Pyramidal‐bladed trocar

Single‐bladed trocar

Visceral injury

No events reported

No events reported

Not estimable1

28
(1 study)

⊕⊝⊝⊝
very low2,3

‐

Vascular injury

No events reported

No events reported

Not estimable1

28
(1 study)

⊕⊝⊝⊝
very low2,3

‐

Trocar site herniation

No events reported

No events reported

Not estimable1

28
(1 study)

⊕⊝⊝⊝
very low3,4

‐

*The basis for the assumed risk is the mean control group risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; OR: odds ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 No events reported.
2 Downgraded one level due to high risk of selection bias: unclear randomisation and allocation.
3 Downgraded two levels due to imprecision: only 28 participants.
4 Downgraded one level due to risk of bias: attrition bias due to unclear loss to follow‐up and performance bias.

Figuras y tablas -
Summary of findings 4. Single‐bladed trocar compared to pyramidal‐bladed trocar for laparoscopy
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Comparison 1. Radially expanding trocar versus cutting trocar for primary and secondary port entry

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Visceral injury Show forest plot

4

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only

2 Vascular injury Show forest plot

4

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only

3 Trocar site herniation Show forest plot

4

463

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Trocar site bleeding Show forest plot

5

553

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.28 [0.14, 0.54]

5 Trocar site haematoma Show forest plot

2

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only
Figuras y tablas -
Comparison 1. Radially expanding trocar versus cutting trocar for primary and secondary port entry
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Comparison 2. Conical blunt‐tipped trocar versus cutting trocar for secondary port entry

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Visceral injury Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only

2 Vascular injury Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only

3 Trocar site herniation Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only

4 Trocar site bleeding, intraoperative Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only
Figuras y tablas -
Comparison 2. Conical blunt‐tipped trocar versus cutting trocar for secondary port entry
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Comparison 3. Radially expanding trocar versus conical blunt‐tipped trocar for secondary port entry

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Visceral injury Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only

2 Vascular injury Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only
Figuras y tablas -
Comparison 3. Radially expanding trocar versus conical blunt‐tipped trocar for secondary port entry
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Comparison 4. Single‐bladed trocar versus pyramidal‐bladed trocar

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Visceral injury Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only

2 Vascular injury Show forest plot

1

Peto Odds Ratio (Peto, Fixed, 95% CI)

Subtotals only
Figuras y tablas -
Comparison 4. Single‐bladed trocar versus pyramidal‐bladed trocar
Ir a la tabla de la revisión