Transumbilical laparoscopic surgery using <scp>G</scp>el<scp>P</scp>ort through an umbilical zigzag skin incision

Hachisuka, Takehiro; Kinoshita, Takashi; Yamakawa, T; Kurata, Nori; Tsutsuyama, Masayuki; Umeda, Shinichi; Tokunaga, Seisaku; Yarita, Akinaga; Shibata, Masafumi; Shimizu, Dai; Shikano, Takaaki; Hattori, Keisuke; Mori, Taisuke; Sakai, Masahiko; Miyauchi, Mutsumi

doi:10.1111/j.1758-5910.2011.00113.x

Cited by 20 publications

(27 citation statements)

References 8 publications

(15 reference statements)

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“…Therefore, the shorter length of the umbilical incision does not increase the difficulty of RPS in terms of laparoscopic handling. Fujii et al (13) reported that the median length of the skin incision was 3.3 cm in SILS for CRC, and Hachisuka et al (14) reported on the zigzag skin incision in RPS for CRC. An incision was required from above to below the umbilical ring.…”

Section: Discussionmentioning

confidence: 99%

Z skin incision in reduced-port surgery for colorectal cancer

Fujino

Miyoshi

Ohue

et al. 2016

Molecular and Clinical Oncology

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Abstract. Laparoscopic surgery for colorectal cancer (CRC) has recently gained in popularity due to the fewer trocars and shorter incision, leading to reduced wound pain and improved cosmetic outcome. In July, 2013, reduced-port surgery (RPS) was introduced and has been performed thereafter in our hospital. An umbilical incision is used for a main port in RPS, through which the specimen is removed and the anastomosis is performed. In order to make the incision shorter, we introduced the Z skin incision in RPS. In this study, we aimed to discuss this method and evaluate the short-term outcome. Among CRC patients undergoing RPS, Z skin incision (n=14) was compared to conventional skin incision (n=15). The clinical and surgical factors were evaluated and there were no significant differences in terms of gender, age, body mass index, tumor site, procedure, operative time, blood loss or complications between the two groups. The median incision length at the umbilicus was significantly shorter in the Z incision group (P=0.004). Particularly in functional end-to-end anastomosis, the median incision length was 2.5 cm in the Z skin incision group and 4.0 cm in the conventional incision group (P=0.018). In conclusion, Z skin incision is a useful technique for achieving an effective length of skin incision in RPS for CRC. IntroductionIn recent years, laparoscopic surgery has been widely performed for colorectal cancer (CRC) in a number of institutions. It has been reported that the efficacy of laparoscopic surgery is due to the reduced blood loss, shorter hospital stay, decreased postoperative pain, earlier postoperative recovery and improved quality of life, with oncological outcomes comparable to those with open surgery (1-3). Conventional multiport laparoscopic surgery for CRC is mainly performed using five trocars, namely one for the laparoscopist, two for the operator and two for the assistant. Recently, efforts have been made to reduce the number of trocars and perform a shorter skin incision, in order to reduce wound pain and provide a better cosmetic outcome; therefore, single-incision laparoscopic surgery (SILS) and reduced-port surgery (RPS) have been applied in colectomies (3-7). In SILS and RPS, an umbilical incision is used for multi-trocar access, to remove the specimen and perform the anastomosis; thus, the length of the umbilical skin incision depends on these procedures. A shorter umbilical skin incision may reduce postoperative pain and provide a better cosmetic outcome. A Z-shaped skin incision has been used in orthopedics and plastic surgery (8). The Z-shaped skin incision is used for the relaxation of scar contractures and it may provide an incision that is longer compared with a straight line (9). We attempted to perform a shorter umbilical incision using this method and we herein report the usefulness of the Z skin incision in RPS for CRC. Patients and methods Patients.A total of 33 patients underwent RPS for CRC at the Osaka Medical Center for Cancer and Cardiovascular Diseases (Osaka, Japan) betwee...

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Section: Discussionmentioning

confidence: 99%

Z skin incision in reduced-port surgery for colorectal cancer

Fujino

Miyoshi

Ohue

et al. 2016

Molecular and Clinical Oncology

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“…A previous report described that a zigzag incision in the umbilical region had clinical values resembling our procedures but required collaboration with plastic surgeon for keeping aesthetics after surgery. 17 Meanwhile, a Z-shaped incision is simple procedure without requiring any collaboration with a plastic surgeon.…”

Section: Discussionmentioning

confidence: 99%

Application of a Z-Shaped Umbilical Incision and a Saline-Cooled Radiofrequency Device to Single-Incision Laparoscopic Surgery for a Huge Liver Cyst: Report of a Case

Igami

Tsuchiya

Yokoyama

et al. 2015

International Surgery

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When compared with other diseases, few authors have reported on single-incision laparoscopic surgery (SILS) for liver cysts. We herein describe our experience with SILS for a huge liver cyst with the application of an umbilical Z-shaped incision using a gel port and a high-density monopolar saline-cooled radiofrequency device with a successful outcome. An 80-old-year woman was diagnosed with a huge liver cyst with abdominal pain. She underwent percutaneous drainage of the liver cyst and injection of both absolute ethanol and an antimicrobial agent into the liver cyst at the previous hospital. Because of re-expansion of the liver cyst and symptom recurrence, we performed SILS for the liver cyst. An umbilical Z-shaped incision was made for gel port placement. After aspiration of the cystic fluid and dissection of the thin cystic wall by laparoscopic coagulating shears, the thick cystic wall was divided using an endoscopic linear stapler to avoid bleeding and bile leakage. After wide fenestration, a high-density monopolar saline-cooled radiofrequency device was applied for the ablation of the remnant membrane of the cystic wall. All maneuvers could be performed only through the gel port. The patient was discharged 4 days after surgery and was satisfied with the cosmetic results. This case shows that the application of an umbilical Zshaped incision using a gel port and a high-density monopolar saline-cooled radiofrequency device is useful for the accomplishment of SILS for a huge liver cyst.

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“…Resected specimens can be removed through the umbilical skin incision, after which anastomosis can be performed. The umbilical zigzag skin incision was first developed to create a 6-cm fascial and peritoneal opening for performing abdominal laparoscopic procedures [21]. We adopted both the umbilical zigzag skin incision and use of an access device to maintain the pneumoperitoneum during laparoscopic colectomy via reduced port surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The skin was cut along a zigzag line marked in the umbilical region (fig. 1a), and the subcutaneous tissue, linea alba, and peritoneum were incised as previously described [21]. A GelPOINT (Applied Medical, Rancho Santa Margarita, Calif., USA) or EZ Access (Hakko, Nagano, Japan) was used as the umbilical access device (fig.…”

Section: Methodsmentioning

confidence: 99%

“…Potential advantages of our procedure include that it provides a balance between cosmetic outcomes and technical difficulty of laparoscopic colectomy. Here, we describe our experience and the technical strategies of laparoscopic complete mesocolic excision via reduced port surgery using an access device through an umbilical zigzag skin incision [21] to treat patients with colon cancer.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic Complete Mesocolic Excision via Reduced Port Surgery for Treatment of Colon Cancer

Mori

Kita²,

Baba³

et al. 2015

Dig Surg

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Background: Laparoscopic colectomy has become accepted for resection of colon cancer, and laparoscopic complete mesocolic excision (CME) has proved feasible and safe. We have evaluated the safety, efficacy, and feasibility of laparoscopic CME via reduced port surgery (RPS) in patients with colon cancer. Methods: We prospectively assessed 17 consecutive patients with colon cancer undergoing laparoscopic CME via RPS between February 2012 and January 2014. Video recordings were used to assess the quality of the surgery, including CME completion. We also assessed operative data, complications, pathological findings, visual analog scale (VAS), cosmesis, and the hospital length of stay. Results: All patients underwent en bloc resection of mesocolon with CME completion. The median surgical duration and blood loss were 298 min and 41 ml, respectively. No intraoperative complications occurred in any patient. The median number of lymph nodes retrieved was 20, with lymph node metastasis identified in eight patients. The mean VAS scores for postoperative days 1, 3, and 7 were 3.2, 1.5, and 0, respectively. All patients were satisfied with their cosmesis. The median postoperative hospital stay was 11 days. Conclusions: Laparoscopic CME via RPS for colon cancer is a safe and feasible surgical procedure with cosmetic advantages.

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Transumbilical laparoscopic surgery using GelPort through an umbilical zigzag skin incision

Abstract: We developed an umbilical zigzag skin incision technique to perform abdominal laparoscopic operations using a GelPort, with a minimal number of skin incisions. We consider that our method reduces the technical difficulties associated with laparoscopic surgery and maintains cosmesis.

Cited by 20 publications

References 8 publications

Z skin incision in reduced-port surgery for colorectal cancer

Z skin incision in reduced-port surgery for colorectal cancer

Application of a Z-Shaped Umbilical Incision and a Saline-Cooled Radiofrequency Device to Single-Incision Laparoscopic Surgery for a Huge Liver Cyst: Report of a Case

Laparoscopic Complete Mesocolic Excision via Reduced Port Surgery for Treatment of Colon Cancer

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