Page 3 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
First Port Access Using an Optical Trocar in Advanced Upper

Gastrointestinal Tract Laparoscopic Surgeries

2
1
Mohab G Elbarbary , Alaa Elashry , Islam Hossam El-Din El-Abbassy 3
Received on: 24 January 2022; Accepted on: 06 September 2022; Published on: 07 December 2022

AbstrAct
Background: Multiple techniques for creation of pneumoperitoneum and first port introduction in laparoscopic surgeries are being used with
a variety of benefits and hazards. Our study was conducted to present the safety and simplicity of using an optical trocar for the establishment
of pneumoperitoneum and first port access through Palmer’s point for advanced upper gastrointestinal tract (GIT) surgeries.
Materials and methods: All patients listed for advanced upper GIT laparoscopic procedures were included in the study, whereas patients who
had splenomegaly, hepatomegaly or the previous left upper quadrant surgery were excluded. A 12-mm optical trocar was introduced with a
0°-degree camera through Palmer’s point in a fully controlled way under complete direct vision, followed by the introduction of the required
working ports to perform the targeted operation. The time of first port introduction, creating pneumoperitoneum, as well as complications
during or after the procedure were recorded.
Results: The study included 1,560 patients who had advanced laparoscopic upper GIT surgeries. Our technique was successful except in
two patients (0.12%) due to massive adhesions of previous operations. The mean time to induce pneumoperitoneum and abdominal access
was 120s. Port-site infection occurred in 0.19%, whereas enterotomy occurred in 0.12%. No port-site hematomas, hernias, or vascular injuries
were noted.
Conclusion: Using an optical port at Palmer’s point in a fully controlled way allows a fast, easy and safe method for first port access and creating
pneumoperitoneum in laparoscopic surgeries. However, special care is still required for patients with the previous abdominal surgeries to
decrease the risk of bowel injuries.
Keywords: Bowel injury, Open method, Optical port, Palmer’s point, Veress needle.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1521

IntroductIon
1,2 Department of General Surgery, Ain Shams University, Cairo, Egypt
Laparoscopy is considered the gold standard technique used
nowadays in all upper GIT surgeries. Despite the rise in the learning 3 Department of General Surgery, Faculty of Medicine, Ain Shams
curve of laparoscopic use and the recent technical advances in University, Cairo, Egypt; Raigmore Hospital, NHS Highland, United
minimally invasive surgical techniques, a safe first port access Kingdom; Institute of Medical Sciences, University of Aberdeen,
and creation of pneumoperitoneum continues to be a challenge Aberdeen, United Kingdom
for all surgeons. Complications related to the entry technique Corresponding Author: Islam Hossam El-Din El-Abbassy, Department
might hinder the operation performance or could be a cause of of General Surgery, Faculty of Medicine, Ain Shams University, Cairo,
1
death. Various methods had been used for years including Veress Egypt; Raigmore Hospital, NHS Highland, United Kingdom; Institute of
Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom,
needle technique; however, because of its slow insufflation rates Phone: +44 7871798087, e-mail: islamelabbassy@hotmail.com
and potentially life-threatening complications, it becomes an How to cite this article: Elbarbary MG, Elashry A, El-Abbassy IHED. First
undefendable mistake to use it in many countries. 2 Port Access Using an Optical Trocar in Advanced Upper Gastrointestinal
The open technique method for port insertion in laparoscopy Tract Laparoscopic Surgeries. World J Lap Surg 2022;15(3):189–192.
3
was first introduced in 1971 by Hasson. This technique allows direct Source of support: Nil
vision and safe entry for the first port avoiding vascular and organ Conflict of interest: None
injury as well as immediate recognition and repair for the injury
4,5
if happened. There are also other methods of intra-abdominal
entry including direct trocar insertion, radially expanding trocars complications. However, using the open technique is considered
and visual entry systems. 6 a challenge in morbidly obese patients and consume much more
The advantages and disadvantages of closed or open methods time for introduction with a higher rate of postoperative port-site
for creation of pneumoperitoneum and introduction of first port infections and hernias. 15
safely were evaluated by many clinical studies. However, the Palmer’s point was first described by Raoul Palmer in 1974,
7,8
definite answer to know the ideal technique is still unclear. Many which is a point located in the left upper quadrant, 3 cm below
10
9
studies using modified techniques of both open and closed basic the costal margin in the mid-clavicular line. This entry point is
16
approaches have been carried out, while others are underway. The utilized when midline adhesions are suspected. It should also
17
older randomized controlled studies, 11,12 as well as the more recent be considered in both obese and thin patients. Entry through
studies, 13,14 in many countries proved that the open technique Palmer’s point using Veress needle insufflation has been reported
is as quick as closed methods and associated with fewer minor by different studies. 18,19 It has been mentioned that the correct
© The Author(s). 2022 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to
the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.