DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20193145

Trans umbilical first trocar access during laparoscopic surgery

Ritvik Resutra, Neha Mahajan, Rajive Gupta

Abstract


Background: In order to perform laparoscopic procedures, it is necessary to first access the peritoneal cavity and establish carbon dioxide pneumoperitoneum. The placement of the first trocar remains a critical step in laparoscopic surgery. In order to minimize complications associated with placement of first trocar, several techniques have been reported. Author describe a surgical technique that provides a quick, safe, and reliable initial access to the peritoneal cavity with its excellent functional and cosmetic results.

Methods: Retrospective study of patients who underwent various laparoscopic procedures at Maxx lyfe Hospital, Bathindi, Jammu was carried out by the closed technique for initial access to the peritoneal cavity through the umbilicus from July 2016 to May 2019. In this study, patients who had a prior midline laparotomy with involvement of the umbilicus were excluded.

Results: Authors analyzed 456 patients (M = 190; F = 266) in the study period. Average age of the patients was 32 years (range:12-86). A physiologic defect was identified in the umbilical region in all patients who had no history of previous abdominal surgery in that region. The average time to access the peritoneal cavity was 30 seconds (range: 20-50).

Conclusions: This technique is quick, safe, reliable, simple, and easy to learn and easy to perform. It is associated with no mortality and minimal morbidity and has excellent cosmetic results. Based on authors experience, authors believe that this method provides surgeons with an effective and safe way to insert the first trocar and recommend it as a routine procedure to access the peritoneal cavity for abdominal laparoscopic surgery.


Keywords


Closed technique, Laparoscopy, Pneumoperitoneum, Port, Umbilicus, Veress needle

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References


Neudecker J, Sauerland S, Neugebauer E, Bergamaschi R, Bonjer HJ, Cuschieri A, et al. The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery. Surgl Endosc. 2002; 16(7):1121-43.

Perunovic RM, Scepanovic RP, Stevanovic PD, Ceranic MS. Complications during the establishment of laparoscopic pneumoperitoneum. J Laparoendosc Adv Surg Tech A. 2009;19(1):1-6.

Munro MG. Laparoscopic access: complications, technologies, and techniques. Current Opinion in Obstetrics and Gynecology. 2002;14(4): 365-74.

Rosen DM, Lam AM, Chapman M, Carlton M, Cario GM. Methods of creating pneumoperitoneum: a review of techniques and complications. Obstetrical and Gynecological Survey. 1998; 53(3):167-74.

Hasson HM. A modified instrument and method for laparoscopy. Am J Obst Gynecol. 1971;110(6):886-7.

Vilos GA, Ternamian A, Dempster J, Laberge PY, Vilos G, Lefebvre G, et al. Laparoscopic entry: a review of techniques, technologies, and complications. J Obstet Gynecol Can. 2007;29(5):433-65.

Inan A, Sen M, Dener C, Bozer M. Comparison of direct trocar and veress needle insertion in the performance of pneumoperitoneum in laparoscopic cholecystectomy. Acta Chirurgica Belgica. 2005; 105(5):515-8.

Schäfer M, Lauper M, Krähenbähl L. Trocar and Veress needle injuries during laparoscopy. Surgi Endoscop. 2001;15(3):275-80.

Schoonderwoerd L, Swank DJ. The role of optical access trocars in laparoscopic surgery. Surg Technol Int. 2005;14:61-7.

String A, Berber E, Foroutani A, Macho JR, Pearl JM, Siperstein AE. Use of the optical access trocar for safe and rapid entry in various laparoscopic procedures. Surg Endosc. 2001;15(6):570-3.

Ma L, Sun N, Liu X, Jiao Y, Zhao H, Deng XW. Organ-specific expression of Arabidopsis genome during development. Plant Physiol. 2005;138(1):80-91.

Merlin TL, Hiller JE, Maddern GJ, Jamieson GG, Brown AR, Kolbe A. Systematic review of the safety and effectiveness of methods used to establish pneumoperitoneum in laparoscopic surgery. Br J Surg. 2003;90(6):668-79.

Ballem RV, Rudomanski J. Techniques of pneumoperitoneum. Surgical laparoscopy & endoscopy. 1993;3(1):42-3.

Sadhu S, Jahangir TA, Sarkar S, Dubey SK, Roy MK. Open port placement through the umbilical cicatrix. Indian J Surg. 2009;71(5): 273-5.

Azevedo JL, Azevedo OC, Miyahira SA, Miguel GP, Becker OM, Hypólito OH, et al. Injuries caused by Veress needle insertion for creation of pneumoperitoneum: a systematic literature review. Surg Endosc. 2009;23(7):1428-32.

Barwijuk AJ, Jakubiak T, Dziag R. Use of the Hasson technique for creating pneumoperitoneum in laparoscopic surgery. Ginekologiapolska. 2004;75(1):35-8.

Lal P, Singh L, Agarwal PN, Kant R. Open port placement of the first laparoscopic port: a safe technique. JSLS. 2004;8(4):364-6.

Lal P, Sharma R, Chander J, Ramteke VK. A technique for open trocar placement in laparoscopic surgery using the umbilical cicatrix tube. Surg Endosc. 2002;16(9):1366-70.

Bonjer HJ, Hazebroek EJ, Kazemier G, Giuffrida MC, Meijer WS, Lance JF. Open versus closed establishment of pneumoperitoneum in laparoscopic surgery. Br J Surg. 1997;84(5):599-602.

Taye M. Open Versus Closed Laparoscopy: Yet an Unresolved Controversy. JCDR. 2016;10(2):QC04.

Lal P, Vindal A, Sharma R, Chander J, Ramteke VK. Safety of open technique for first-trocar placement in laparoscopic surgery: a series of 6,000 cases. Surgical Endoscopy. 2012;26(1):182-8.

Penfield AJ. How to prevent complications of open laparoscopy. Jo Reprod Med. 1985;30(9):660-3.

Esposito C. Transumbilical open laparoscopy: a simple method of avoiding complications in pediatric surgery. Pediatr Surge Int.1997;12(2/3):226-7.

Moberg AC, Petersson U, Montgomery A. An open access technique to create pneumoperitoneum in laparoscopic surgery. Scandinavian J Surge. SJS :official organ for the Finnish Surgical Society and the Scandinavian Surgical Society. 2007;96(4):297-300.