A trocar fixation device can comprise a cannula, at least one flap coupled to an exterior surface of the cannula within a central region of the cannula, and an elongate tube rotatably mounted onto the cannula and over the at least one flap. The elongate tube has at least one opening extending between an interior surface and an exterior surface of the elongate tube. In a free, activated state, the flap biases radially outwardly from the cannula. In a constrained, deactivated state, the at least one flap is positioned between the cannula and the elongate tube and maintained substantially parallel to the exterior surface of the cannula. The at least one opening in the elongate tube is sized and positioned such that rotation of the elongate tube in a first direction about the cannula exposes the flap in its entirety through the opening and allows the flap to activate.