Tips for Proper Trocar Insertion

brandon llewellyn | 13 December, 2023

            Tips for Proper Trocar Insertion

Hormone pellet insertion is a useful way to provide men and women with effective hormone replacement therapy (HRT). The placement of the trocar during the pellet procedure plays an important role in the success of the treatment, so practitioners should be well-versed in proper trocar placement for different patients.

Here’s what to know about the best HRT trocar placement sites, how to choose the right size trocar kit, and effective techniques for patient insertion.

General Procedure for Trocar Placement

Trocar insertion is easy with a disposable trocar kit and most medical practitioners can usually complete the entire procedure in just a few minutes. Patients may feel some pressure and discomfort, but insertion isn’t painful for most people.

First, the patient is positioned on the procedure table, so the practitioner can access the trocar insertion site. Then, the sterile field is prepared and the patient is cleaned and numbed for the insertion procedure. A small incision is made into the subcuticular tissue and the trocar is inserted at a 45-degree angle to place the pellet deep into the fat layer.

Once the pellet is inserted, the trocar is removed and pressure is applied to the incision. Disposable trocar kits can then be thrown away in their entirety, without the need forsterilization and prep for the next procedure. The incision can be closed with Steri-strips or a few dissolvable stitches depending on the provider's preference.

HRT Trocar Insertion Placement Sites

It’s imperative that practitioners choose a placement site based on each patient’s weight, medical history, and other individual circumstances. Choosing the wrong site for someone can lead to prolonged discomfort for the patient and can make the pellet more likely cause problems. Here are the most common HRT pellet placement sites and how to choose the area for the right patient:

Gluteal Insertion Placement

For most people receiving hormone therapy, HRT pellets are placed in the upper outer region of either the left or right buttock, below the waistline. This allows for the pellet to be inserted into an area with maximum fat retention and minimum external interference. 

Abdominal Insertion Placement

Abdominal placement may be ideal for patients who have more body fat around their abdomen than in their hips and buttocks. The pellet may be inserted into any fatty tissue in the lower abdomen between the groin and the waistline, which gives medical providers more flexibility when choosing a surgical site.

However, this placement site may not be a good choice for very overweight patients or whose fat distribution is largely in their abdominal area due to the risk of pellet migration.

Flank insertion is also a commonly used insertion site. 

Inguinal Insertion Placement

Inguinal placement is uncommon for pellet therapy, but it may be used in some circumstances where abdominal and gluteal placement aren’t desirable. For this procedure, the pellet is inserted low in the groin area below the swimsuit line, either to the left or right of the navel.

Choosing the Proper Trocar Size Kit

Choosing the right sizetrocar kit is crucial for procedure success. An improperly sized kit will result in poor pellet placement, potentially causing infection, pellet rejection, and other complications.

Trocar kits generally come in three sizes:

  • 3.2 mm – Short trocars are better suited for thin patients and individuals without much body fat in the ideal insertion areas.
  • 3.5 mm – These standard-size trocars are the most commonly used for pellet insertion for patients with average body types.
  • 4.5 mm – Long trocars are required for proper pellet insertion for overweight or obese patients.

Each size can be purchased with either adiamond orbevel tip for minimal tissue damage and maximum results.


Patients with Increased Risk of Complications

No two pellet insertion procedures are the same, and it’s critical for medical providers to take into account each patient’s condition, body size, and other individual criteria before choosing a trocar size and placement site for someone. Providers can help reduce the increased risk of complications for certain patients by adjusting the trocar insertion procedure to suit their specific needs.

For example, patients with bleeding disorders may still be a candidate for pellet therapy if a provider uses abdominal placement in a less vascular area. Or, patients who are prone to keloid scarring may be able to have their pellet inserted in the inguinal area to keep the scar below the bikini line.

Here are some more helpful tips for proper trocar insertion and pellet placement for different types of patients:

Obese Patients

Overweight andobese patients typically require insertion with longer trocars to ensure that pellets are placed deep enough into the patient’s fatty tissue to work properly. Medical practitioners may also need to make a larger incision to adequately position the hormone pellet.

Patients with larger bodies are well-suited to gluteal placement, since abdominal placement may be more difficult with overlapping areas of skin and fatty tissue. Inguinal insertion is generally contraindicated for patients with a large panniculus that extends over the groin, regardless of whether they are male or female.

Very Thin Patients

Patients who are very thin need a delicate hand when it comes to trocar insertion and pellet placement. Usually, shorter trocars are better for these individuals and smaller incisions can be made to accommodate them.

Which area is best for insertion depends on the patient’s body fat distribution. Even if they have very little, try to choose the area with the thickest subcutaneous layer. This is often in the gluteal region, but may be in the abdomen.

Choose a HRT Medical Device Supplier for Your Practice

Trocar Supplies is a leading provider of HRT medical devices and disposable trocar kits for pellet therapy. We offer a broad selection of different size trocars to choose from, and each tray is specifically designed for the practitioner’s convenience and ease of use.

Browse ourproduct catalog today orcontact us by calling (937) 478-0469, and we’ll be happy to answer your questions and guide you to the right products for your practice needs.