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WJOLS

Sarbjeet Singh, Delie Rhezhii 10.5005/jp-journals-10033-1251
ORIGINAL ARTICLE

Laparoscopic Surgery: Results of a Modified Open

Technique of Umbilical Port Insertion

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1 Sarbjeet Singh, Delie Rhezhii

ABSTRACT a period from 2011 to 2012. A modified technique of open
Insertion of first port and creation of pneumoperitoneum is method of creating pneumoperitoneum in laparoscopic
a key step in laparoscopic surgery. A significant number of surgery was performed in these patients after taking
complications can be avoided by safe insertion of primary port. detailed informed consent. Indication for laparoscopy
Various techniques of umbilical port insertion and their safety in these patients was cholecystectomy (90%), diagnostic
have been mentioned in literature. Closed method by using
Veress needle is a blind procedure. Studies have shown that laparoscopy (8%), laparoscopic liver abscess drainage
vascular injuries are more common with the Veress needle. (2%). Patients with cardiac diseases, chronic respira-
Hasson first introduced the open technique of port insertion tory diseases, bleeding disorders, extensive abdominal
under direct vision. We used a modified open technique and
analyzed the safety and efficacy in 80 cases. scars, suspected cases of malignancy and adhesions
due to previous surgery or peritonitis and pregnant
Keywords: Laparoscopic surgery, Open technique, Umbilical
port. patients were excluded from the study. Results were
How to cite this article: Singh S, Rhezhii D. Laparoscopic analyzed in terms of technical difficulty, time taken
Surgery: Results of a Modified Open Technique of Umbilical for umbilical port insertion, intraoperative gas leak,
Port Insertion. World J Lap Surg 2015;8(3):72-74. port closure time and complications, such as vascular
Source of support: Nil injury, visceral injury, postoperative incisional hernia

Conflict of interest: None and umbilical sepsis.

INTRODUCTION TECHNIQUE
In laparoscopic surgery, open method of primary port After paint and drape, surgeon stands on right side of
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insertion was first described by Hasson in 1971. The port patient. A semicircular, skin incision about 1.5 cm is
is inserted under direct vision. Another technique is by made in infraumbilical crease and skin is retracted with
blind insertion of Veress needle, which is associated with langenback retractors. Umbilical skin is held with a towel
some serious complications, such as gas embolism, vas- clip and lifted up. Subcutaneous fat is dissected to expose
cular injury and injury to hollow viscus. So, Hasson’s umbilical stack and its junction with rectus sheath (Fig. 1).
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open method is considered superior to closed method Umbilical stalk is stretched by pulling the towel clip up.
because of lower rate of complications associated with using no. 11 surgical blade, a vertical incision, about 1 cm
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former. In literature, various open techniques for creation is made on umbilical stalk, starting from its junction with
of pneumoperitoneum are mentioned. In present study rectus sheath and extending upward. While maintaining
we practiced a modified technique of open method of upward traction on anterior abdominal wall, using tip of
creating pneumoperitoneum with the objective of evalu-
ating its complications and efficacy.
METHODS

A prospective study was conducted upon 80 conse
cutive cases in the department of general surgery during

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1 Assistant Professor, Resident
1,2 Department of Surgery, Guru Gobind Singh Medical College
Faridkot, Punjab, India
Corresponding Author: Sarbjeet Singh, Assistant Professor
Department of Surgery, Guru Gobind Singh Medical College
223, Medical Campus, Faridkot, Punjab, India, Phone:
9855602532, e-mail: drsarab21@gmail.com
Fig. 1: Dissection of umbilical pillar
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