Laparoscopic Surgery and Trocars: Two Intertwined Lines of Development

Laparoscopic surgery and the trocar have evolved in tandem, each advancing the other. The milestone of laparoscopy dates to 1987, when a French surgeon performed the first modern laparoscopic cholecystectomy; the trocar's prototype, meanwhile, traces back to the 19th-century "Southey tube." It is this constant convergence of the two threads that has given rise to today's efficient, safe, and truly minimally invasive surgery.

1. The Evolution of Laparoscopic Surgery
   1. Early Exploration (c. 1901):In 1901, Russian physician Ott made the first attempts at intra-abdominal endoscopy, while German surgeon Georg Kelling conducted related experiments—the earliest explorations of laparoscopic technique.
   2. The Technical Foundation (1938):Hungarian surgeon Veress invented the spring-loaded Veress needle, which safely establishes pneumoperitoneum while protecting intra-abdominal organs from injury—the critical foundation of laparoscopy.
   3. The Birth of Modern Laparoscopy (1987):French surgeon Philippe Mouret performed the world's first modern laparoscopic cholecystectomy—no large incision, just a few small ports. Laparoscopy rapidly spread across the globe.
   4. Arrival in China (1991):On February 19, 1991, Xun Zuwu performed China's first video-assisted laparoscopic cholecystectomy, a milestone in the history of Chinese minimally invasive surgery; that same year, laparoscopy was introduced into gynecologic surgery.

2. The Evolution of the Trocar
   1. The Prototype (19th Century):British physician Reginald S. Southey invented the "Southey tube" for draining subcutaneous fluid. By adding a cannula and openings, it formed the earliest prototype of the trocar.
   2. The Key Invention (1938):Veress developed the spring-loaded needle whose blunt outer sheath automatically retracts upon penetrating the abdominal wall, protecting intra-abdominal organs—an essential foundation of trocar development.
   3. Modern Evolution (from 1981):As laparoscopic technique advanced, the trocar evolved into a dedicated instrument for establishing surgical access. In 1981, the Trocar-needle technique of Pfister et al. and the Catheter-needle technique of Segal et al. appeared.
   4. Localization and Innovation (Recent Years):Chinese manufacturers have made breakthroughs in membrane seal airtightness and obturator tip design, with some products achieving import substitution. Recent years have seen continuous innovation toward single-use design, visualization-enabled obturators, and enhanced sealing performance—alongside the emergence of integrated "access-and-closure" concepts as a new direction for the field.

3. From "Establishing Access" to "Closure"—the Revolutionary Significance of TroClose
   

• • • Integrated Design:Puncture and suturing functions are combined into a single device composed of an obturator and a cannula. It is indicated for gynecologic, general, and urologic endoscopic procedures—creating and maintaining the port while enabling closure of the port site afterwards, reducing instrument exchanges and procedural steps.
    • 0% Port-Site Hernia Assurance:Its unique 180-degree suture deployment forms a half-loop knot system. Compared with conventional full-loop techniques, tissue tension is reduced by 75%, and clinical validation demonstrates a 0% port-site hernia rate—eliminating hernia risk at its source.
    • High-Efficiency Surgery:The half-loop closure technique saves an average of 20 minutes of operative time. The all-in-one system reduces the number of single-use items required, optimizing inventory while helping healthcare providers move toward net-zero carbon emissions.
    • Ease of Clinical Use:The short learning curve allows surgeons to use it reliably without extensive training. It enables safe port-site closure without maintaining pneumoperitoneum or additional visualization, aligning with the 2021 SAGES recommendation.
    • Safety and Cost Reduction:It reduces intraoperative device use and complication-treatment costs, lowering postoperative pain and narcotic usage at one week and accelerating patient recovery.

The TroClose series originated from an R&D project supported by the Israel Innovation Authority, with a US$10 million lead investment from German medical-device giant B. Braun. It received U.S. FDA clearance and EU CE marking in 2016 and is marketed in Israel, Turkey, and Latin America, with more than 3,000 clinical applications in the U.S. and Germany and a surgeon satisfaction score of 9.8/10. Lujian Technology introduced the series to China in 2022 and, based on the clinical needs of the Chinese and international markets, systematically optimized its structural design, manufacturing stability, production adaptability, and regulatory pathway—iterating it to TroClose 2.0, which obtained FDA clearance and completed import substitution and local transformation. The series is protected by a global intellectual-property moat of more than 30 core patents, with Lujian Technology holding worldwide exclusive manufacturing rights and exclusive commercialization rights for the China region.

4. The Relationship Between the Two

The trocar is an indispensable consumable in laparoscopic surgery. During a laparoscopic procedure, the surgeon first makes a small incision in the abdomen, inserts a Veress needle to establish pneumoperitoneum with CO₂, and then uses a trocar to create the working channel through which the endoscope and surgical instruments enter the abdominal cavity. In short, without a trocar to establish the access channel, laparoscopic surgery cannot proceed—and with the advent of TroClose, the trocar has evolved from a mere "access device" into an integrated "access-and-closure" system, setting a new standard for the safety and efficiency of laparoscopic surgery.