First Port Access Using an Optical Trocar in Advanced Upper Gastrointestinal Tract Laparoscopic Surgeries
Mohab G Elbarbary, Alaa Elashry, Islam Hossam El-Din El-Abbassy
Bowel injury, Open method, Optical port, Palmer's point, Veress needle
Citation Information :
Elbarbary MG, Elashry A, El-Abbassy IH. First Port Access Using an Optical Trocar in Advanced Upper Gastrointestinal Tract Laparoscopic Surgeries. World J Lap Surg 2022; 15 (3):189-192.
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.
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