Trocar Insertion Procedure

Needed Materials

  • Disposable trocar kit with 3 piece trocar
  • Pellets (implants)
  • Alcohol wipe (to swab the top of the local anesthetic)
  • 1% lidocaine with epinephrine (without epi if allergic)
  • Sodium Bicarbonate
  • Skin tape (paper)

Instructions following insertion of pellet implants

  • Avoid vigorous physical activity for 2 days
    • Stair stepper, elliptical cross trainer, cycling or any activity that uses the gluteal muscles should be avoided immediately following the procedure.
  • You may remove the white gauze dressing and shower the next day.
  • The skin tapes (steri-strips) may be removed in 5-7 days.
  • You may have slight redness around the small incision. This is normal.
  • Minimal discomfort following the procedure is also normal.
  • Infection is very rare (1:100) insertions however if redness and swelling increase after 48 hours you may have a minor skin infection or bruising.
  • You may apply a warm washcloth or heating pad to the area
  • Rarely a prescription for antibiotics (e.g. Keflex) is needed


Procedure

  1. For gluteal insertion, place the patient on their side, rolled slightly anterior leaving enough space to place the disposable trocar kit on the table behind the patient
  2. Place the trocar kit directly behind the patient in line with the (gluteal) insertion site
  3. Place the lidocaine and bicarbonate bottles to the left of the trocar kit and swab the tops of the bottles with an alcohol wipe
  4. Open the trocar kit, turning/folding back the paper edges maintaining an ‘inner’ sterile field (see video)
  5. Once the kit is open, the two ‘pellets’ may be placed in the corner of the tray
    • When opening the glass ampoule, keep your fingers away from the gold circle/breaking point
  6. Sterile gloves will be located on top. If you are not familiar with how to ‘sterile glove’ please review this procedure and practice.
    • If you are right handed, pick up the sterile glove by the cuff with your left hand. Holding it open, glove your right hand. (The cuff does not need to be sterile)
    • If an assistant is present, pick up the second glove with your sterile (gloved) right hand, folding the cuff over your sterile/gloved fingertips. Place the 2nd glove on your left hand.
  7. Have the assistant swab the top (alcohol wipe), invert and hold up the bottles of lidocaine and bicarb while you draw up 2.5-3 cc’s of each solution into the 10 cc syringe. Place the filled syringe back into the tray.
  1. Sterilize/prep the skin using the three betadine swabs applied in concentric circles with the center of the sterile field, at the site of the incision
    • Upper mid-gluteal area, below the waistline
  2. Place the fenestrated drape with the opening over the sterile field
  3. Anesthetize the subcutaneous tract (~5 cm in length) and skin wheal with 5-6 cc’s of local anesthesia: 3cc of 1% lidocaine with epi (or 1% plain) with 3cc sodium bicarbonate (to prevent stinging). Make sure there is avisible skin wheal
  4. Using a #11 blade (held like a pencil), with a slight ‘sawing’ motion, make a small 5-6 mmtransverse skin incision approximately 5-6 mm in depth
  5. Guide the sterile cannula with the sharp trocar into the subcutaneous tissue ~ 3-4cm, from medial to lateral. The tract should be ~ 5 mm in depth and parallel to the skin
  6. Remove the sharp trocar, hold the cannula level and pick up the 2 testosterone-anastrozole (or placebo) pellets into the cannula using the sterile forceps
    • The blunt trocar may be placed in the rear opening so the pellets don’t slide out
  7. Using the sterile blunt trocar, advance the pellets beyond the tip of the cannulaholding the cannulasecurely in place
  8. Remove the cannula/blunt trocar and apply pressure using the sterile gauze pad
  9. Clean the skin using the alcohol wipe while continuing to hold pressure on the incision
  10. Cross skin tapes (steri-strips) over the incision
  11. Apply a dressing and have the patient hold pressure for 5 minutes, 10 minutes if on anti-coagulants or aspirin (anti-inflammatories)