Access without excess: a comparison of wound infections with disposable versus hybrid trocars in minimally invasive inguinal hernia repairs

Abstract Introduction Operating rooms generate 70% of hospital waste. Transitioning from disposable to reusable devices could mitigate surgical waste. Partially reusable, or hybrid, trocars can be used for minimally invasive surgery (MIS), but perceptions of increased infection risk may drive preferences toward disposable trocars. However, no data substantiates this risk. Our analysis of a national hernia outcomes database investigates this presumed association. Methods Using the abdominal core health quality collaborative (ACHQC), we identified high-volume inguinal hernia surgeons who used only disposable trocars for laparoscopic inguinal hernia repair (IHR) and hybrid trocars for robotic IHR. These two surgical approaches served as surrogates to evaluate differences between disposable and hybrid trocars. We performed a query of the ACHQC to identify patients who underwent elective MIS IHR with mesh between 2017 and 2023 by one of the previously identified surgeons. Results A total of 34,638 patients met inclusion criteria. After propensity score matching, there were 1191 patients in each group. There was no difference in rates of surgical site infection (SSI), surgical site occurrence requiring procedural intervention (SSOPI), readmission or reoperation between the two groups. There was a statistically significant higher rate of surgical site occurrence (SSO) in the disposable trocar group (5% vs. 2%, p = 0.003). This was driven by a significantly higher rate of hematomas (12% vs 38%, p = 0.007). Conclusion This study did not find an increased risk of SSI associated with hybrid trocars compared to disposable trocars for MIS inguinal hernia repairs. To decrease surgical waste, surgeons should consider the use of hybrid trocars for laparoscopic surgery.