Trans umbilical laparoscopic access during laparoscopic procedures

Abstract

Introduction: The advent of laparoscopic surgery is one of the most important advances in modern surgical technique. In order to perform laparoscopic procedures it is necessary to first access the peritoneal cavity and establish a pneumoperitoneum. The placement of the first port remains a critical step in laparoscopic surgery. In order to minimize complications associated with placement of this first trocar, several techniques have been reported. We describe a surgical technique that has been developed by our surgical group that provides a quick, safe, and reliable initial access to the peritoneal cavity that is accompanied by excellent functional and cosmetic results. Methods: Retrospective cohort of patients who underwent various laparoscopic procedures by our surgical group using our modified open technique for accessing the peritoneum from January 2000 to September 2012. We excluded patients who had a prior midline laparotomy with involvement of the umbilicus, but not those with previous transverse umbilical herniorrhaphies. Results: We identified 963 patients (M = 419; F = 544) in the study period. Average age of the patients was 40 years (range: 15-83). Median follow up of 2.8 years (range: 6-144 months). No complications occurred during the insertion of the first trocar. A physiologic defect was identified in the umbilical region in all patients who had no history of previous abdominal surgery in that region. Postoperative complications occurred in 39 patients (4.0%). The most common complication was a postoperative seroma, which occurred in 24 patients (2.4%). Superficial surgical site infection occurred in eight patients (0.84%), hematoma in two patients (0.21%), and incisional hernias in the umbilical port site in five patients (0.51%). The average time to access the peritoneal cavity was 1.5 minutes (range: 1-7). Conclusions: We describe a modified open technique for accessing the peritoneal cavity through a small congenital umbilical defect that is almost universally present. This technique is quick, safe, reliable, simple, and easy to learn. It is associated with minimal morbidity and has excellent cosmetic results. Based on our experience, we believe that this method provides surgeons with an effective and safe way to insert the first trocar and we recommend it as a routine procedure to access the peritoneal cavity for abdominal laparoscopic surgery.

Useful Preoperative Simulation of Laparoscopic Surgery for Rectal Cancer in Patients with Kyphosis

“…In patients with kyphosis, the abdominal area is small, and insertion of the laparoscopic ports is difficult. In our case, we inserted the first port from the umbilical region for pneumoperitoneum, because this region is the site of the thinnest abdominal wall with no significant blood vessels, resulting in easy and safe access 7,8 . However, as preoperatively simulated, by inserting the laparoscopic camera from this port, we were not able to achieve a good surgical view because of the acute angle to the pelvic region.…”