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Modified Intraumbilical Versus Infraumbilical Entry Method at Laparoscopy: A Cohort Study.

Javier-Fernando Cuevas-Toledano1, Joaquín-Salvelio Picazo-Yeste, Carlos Moreno-Sanz

  • 1Department of General and Digestive Surgery, La Mancha-Centro General Hospital, Alcázar de San Juan, Ciudad Real, Spain.

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Summary
This summary is machine-generated.

The modified intraumbilical technique (MIT) offers a safer laparoscopic entry, reducing failed entries and complications compared to the Veress needle (VN) technique. This novel approach is a safe and effective alternative for initial umbilical trocar insertion.

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Area of Science:

  • Minimally Invasive Surgery
  • Surgical Techniques
  • Laparoscopic Access

Background:

  • Optimal laparoscopic entry methods lack consensus, with debates on transumbilical vs. periumbilical incisions.
  • Entry techniques like Hasson, Veress needle (VN), and direct trocar each have distinct advantages and disadvantages.
  • A novel modified intraumbilical technique (MIT) combines Veress needle insertion with modified direct-trocar access.

Purpose of the Study:

  • To compare the safety and efficacy of the modified intraumbilical technique (MIT) against the standard infraumbilical Veress needle (VN) technique.
  • To evaluate intraoperative access-related events, entry failures, and long-term wound complications for both techniques.
  • To determine the optimal umbilical trocar insertion route for laparoscopic procedures.

Main Methods:

  • Retrospective cohort study of 406 patients.
  • Analysis of two cohorts: standard infraumbilical Veress needle (VN) technique (n=198) and modified intraumbilical technique (MIT) (n=208).
  • Primary outcomes included intraoperative access events, entry failure, and long-term wound complications, with follow-up at 1, 6, and subsequent years.

Main Results:

  • The VN group showed higher rates of subcutaneous emphysema (P=0.011), extraperitoneal insufflation (P=0.023), and difficult entries (P=0.023).
  • Entry failure occurred in 2.52% of the VN group versus 0% in the MIT group (P=0.085).
  • Seroma of the wound was more frequent in the VN group (P=0.033), while trocar-site hernias were equally distributed (3.20%) after a mean follow-up of 18.4 months.

Conclusions:

  • The MIT eliminates failed entries and reduces VN-related complications without increasing umbilical wound infections.
  • MIT facilitates proper umbilical incision closure, contributing to a low rate of trocar-site hernias.
  • MIT is a safe, feasible, and advantageous alternative to the infraumbilical VN entry, combining benefits of open and closed techniques.