[Usefulness of the trans-umbilical incision in laparoscopic surgery]

Most surgeons induces pneumoperitoneum with the Verres' needle via an infra or a supraumbilical route; only a reduced group does it true the umbilicus. This paper reports the authors experience using the trans-umbilical route emphasizing its differences and advantages over the conventional umbilical approach. The files of our last 100 laparoscopic cholecystectomies performed in different hospitals were reviewed. Trans-umbilical route was used in 93 cases. Four patients were found to have an umbilical hernia with no content in its sac and it did not compromised the approach. In 7 cases the semi-open technique had to be used because of previous abdominal surgery. There were no major complications during the induction of the pneumoperitoneoum; no hematomas infections or post-operative umbilical hernias either, just a mild pneumopreperitoneum occurred in 5 patients. Trans-umbilical approach for pneumoperitoneum induction is useful, safe, easy to repair, has a low infection rate, and provide better cosmetic results; scar is almost invisible deep in the umbilicus. This approach has several advantages over the ordinary umbilical approaches by been cautious and by using the authors' technique, mini-invasive procedures can be initiated quick and safely.