Sutureless pars plana vitrectomy was first proposed by Chen (1), and it was based on 20-gauge (20G) self-sealing scleral tunnels. Many complications were reported and other authors have described modifications for this technique to avoid problems such as wound leakage, dehiscence, hemorrhage, incarceration of vitreous and/or retina, retinal tears, and dialyses (2, 3, 4, 5, 6 and 7).

The use of trocars for sutureless vitrectomy was first described by Fugii et al. (8,9). A scleral perpendicular 25-gauge incision was used, and they suggested that the holes would be closed because they were small and the conjunctiva would also cover them, serving as a protection. However, in minimal surgery, the closure of the sclerotomies is essentially made by the peripheral vitreous, possibly increasing the risk of incarceration and secondary retinal detachment. If this peripheral vitreous were removed in order to avoid this complication, it would increase the possibility of wound leakage and hypotony.

Although the 25-gauge system seemed to be very attractive, reducing surgical time, minimizing trauma, and hastening postoperative recovery, some problems such as flexibility and fragility (10) of the instruments, low infusion and aspiration rates (8) and, of course, higher costs, have limited its use. Since then, many attempts have been made to improve sutureless vitreoretinal surgery.

Eckardt (11) presented, as an alternative to the 25-gauge, a new method using a 23-gauge system. He has used a 30 to 40 degree tunnel incision made with a stiletto and inserted the cannulas using a blunt inserter. This system offers the advantages of a sutureless surgery, but it requires a completely different set of instruments. These instruments are flexible, increasing surgery costs and limiting indications. To avoid the leakage mentioned before in the 25-gauge surgeries, Lópes-Guajardo (12) proposed that the sclerotomies should be done in the same way Eckardt (4) described for 23-gauge surgery, creating scleral tunnels with displacement of the conjunctiva.

We introduced a new 20G transconjunctival trocar system (Dutch Ophthalmic Research Corporation [DORC], Zuidland, Holland) that allows the use of the conventional 20G vitrectomy in sutureless surgeries. It is analogous to the 23-gauge approach. A tangential tunnel is made with a bent stiletto, and the trocars are introduced with a blunt inserter in a two-step technique.

The first generation trocars were designed 3 years ago. A set (Fig. 19-1

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