A 5-mm open umbilical entry technique for laparoscopic gynecologic surgery

Laparoscopic entry carries a complication rate of up to 1.3%, including bowel and vascular injury. The Hasson, Veress, and 5-mm open entry techniques differ in approach: Hasson uses a 1-2 cm open incision, Veress involves blind needle access, and the 5-mm open entry technique uses a small umbilical incision with blunt peritoneal entry followed by insertion of a 5-mm bladeless optical trocar. Previously shown to be safe and easily mastered by both attendings and residents, this study re-evaluates the 5-mm technique in a multi-surgeon setting.

The senior author's extensive clinical experience with this technique informed its continued use and motivated the present retrospective evaluation of all consecutive cases performed between 2021 and 2025. The technique involves tenting the umbilicus with three tonsil clamps, injecting 1 mL of 0.25% bupivacaine, making a 2-4 mm vertical incision within the umbilical scar that is then stretched to approximately 5 mm with a tonsil clamp, and bluntly dissecting the fascia to expose the mid-umbilical fascia and enter the peritoneal cavity. A 5-mm bladeless optical trocar is advanced under direct visualization, and carbon dioxide insufflation begins once placement is confirmed.

All cases achieved successful entry without conversion to Veress. One patient had a Hasson entry for concurrent cholecystectomy. Omental adhesions were present in 15 cases (7.7%). No entry-related complications occurred.

In this cohort, the 5-mm open entry technique was successfully performed without entry-related complications and demonstrated favorable cosmetic outcomes.