Radially expanding laparoscopic access for renal/adrenal surgery (original) (raw)

Transumbilical Laparoscopic Access

Gastroenterology, 2013

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.

Trans-Umbilical Open Port Placement During Laparoscopic Access: A Safe Technique

Journal of Armed Forces Medical College, Bangladesh

Introduction: Intra-peritoneal access and creation of pneumoperitoneum through a quick, safe and reliable technique is important for Laparoscopic Surgery. Specially in an resource constrained setting where there is paucity of needed equipment and cost is prohibitive, utilization of the fewer instruments available and accompanid by excellent functional and cosmetic outcomes should be the aim of a laparoscopic surgeon. Objectives: To describe a modified method of primary trocar introduction that utelizes fewer available instruments. Materials and Methods: A vertical incision is made in the trans-umblical region at the base of to an everted umblicul scar. The linea alba is incised and the resultant opening bluntly developed after which the 1st port is inserted using tocar as an guide. The trocar is withdrawn while the canula is pushed in. Results: We included total 124 patient (Male-44, Female-80) in the study period, from Jan 2017 to December 2018. In one single surgical unit, with th...

The direct trocar technique: an alternative approach to abdominal entry for laparoscopy

JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons

The direct trocar technique is an alternative to Veress needle insertion and open laparoscopy for accessing the abdominal cavity for operative laparoscopy. We review our approach to abdominal entry in 1385 laparoscopies performed between September 1993 and June 2000 by our group at Stanford University Hospital, a tertiary Medical Center. We performed a retrospective chart review of 1385 patients who underwent operative laparoscopy during the study years. The mode of abdominal entry, patient demographics, and complications were reviewed. The transumbilical direct trocar entry method was used in 1223 patients. In 133 patients, the Veress needle insertion technique was used. Open laparoscopy was used in 22 patients. Three (0.21%) major complicadons occurred: 1 enterotomy, 1 omental herniation, and 1 bowel hemiation. One complication was related to primary access (0.072%) in a patient who had an open laparoscopy. She sustained an enterotomy during placement of the primary trocar. The bo...

Direct Trocar Insertion for Laparoscopy

JSLS, Journal of the Society of Laparoendoscopic Surgeons, 2012

The Veress needle (VN) technique for establishing pneumoperitoneum in laparoscopic surgery is widely used and yet is associated with slow insufflation rates and potentially life-threatening complications. Although these complications have been rarely reported, they represent a major source of morbidity and mortality from laparoscopic procedures and a major reason for conversion to open surgery. The open laparoscopy (OL) is an alternative to the VN technique, being relatively safer, even if considered cumbersome by many authors. Recently, the direct trocar insertion (DTI) technique of establishing pneumoperitoneum has been reported as an alternative to both techniques, but it is largely confined to gynecologic procedures. We report a case-series study where we evaluate the patients who underwent a DTI entry for laparoscopy during a recent 5-year period, focusing attention on feasibility, safety, and the benefits of DTI.