Jain Point : To avoid trocar injuries in multiple previous surgeries A retrospective analysis of 720 cases

Abstract

Background: Laparoscopic entry in previous surgery cases has several challenges but complexity rises further in patients with history of multiple previous surgeries leading to intra-abdominal adhesions, visceral, vascular, nerve injuries, dilemma in port placement, difficulty in establishing pnemoperitoneum, reduced visibility and all these leading to longer operative time. To address the above issues, we conducted this study to assess the safety and efficacy of Jain point in avoiding trocar injuries in patients with multiple previous surgeries. Methods: We present a retrospective analysis of 720 cases with two or more previous surgeries conducted at a tertiary care referral centre for advanced gynecological laparoscopic surgery from January 2011 to July 2023. We perform a detailed preoperative work up of the patient and delve into all details of the previous surgeries including indications and nature of surgery, open or laparoscopic. We then inspect all scar sites to assess possible intra-abdominal adhesions and feasibility of Jain point entry. Veress entry is made at Jain point, which lies at L4 level on left side of abdomen, 10-13 cm lateral to the umbilicus. This is followed by primary blind trocar entry at the Jain point, which becomes the main working port in due course of the surgery. We make a note of intraoperative adhesions and postoperative complications. Results: In total 720 cases with history of multiple previous surgeries, laparoscopic entry was safely made through Jain point port by consultants, senior residents and fellows, almost in equal number of cases. In this study group, no major bowel or vascular complications were noted. Conclusion: Jain point laparoscopic entry is safe for all types of previous scars, in all quadrants of abdomen, in all ranges of BMI, age, with varied indications and by surgeons of various subspecialties. It is feasible in low resource settings as in this study we utilized our routine reusable trocars. Jain point has the potential to minimize trocar injuries in hands of novice as well as experts, as its precise location avoids injury to vessels, viscera and bowel; thus posing as a safe and feasible laparoscopic entry port in multiple previous surgeries.