Background: Two-port laparoscopic ventral hernia repair is currently practiced with preferable results. This study was conducted aiming to add to the general safety of trocar placement, and trying to solve the problems of the blind insertion of the primary trocar. This can be achieved by extracorporeal transillumination of the anterior abdominal wall before insertion of the primary trocar; thus, delineating whether the abdominal wall harbors any underlying tissues, and accordingly trying to visualize what is being performed rather than doing it blindly. Materials and methods: This is a single-center study. Patients’ enrollment was carried out between March 2018 and June 2019. They were randomized into two groups: Laparoscopic repair using transillumination before inserting the primary (camera) trocar (group I) and laparoscopic repair only (group II). The primary endpoint was the length of the direct distance between the primary port and the left midaxillary line. This distance is inversely proportional to the distance that will exist between the camera port and the hernial defect. Secondary outcomes involved the duration of the operation and adverse events. Results: The analysis included 46 patients, of whom 23 were randomized to group I and 23 to group II. No significant differences were present regarding patient characteristics or operation times. The direct distances between the primary trocar and the left midaxillary line were significantly less in group I, a median of 35 mm (15–65 mm) than in group II, a median of 75 mm (45–85 mm) (p = 0.013). Conclusion: Extracorporeal abdominal wall transillumination is a promising approach for achieving more safety and confidence in the two-port laparoscopic ventral hernia repair and represents an auxiliary tool for surgeons as a trial to visualize if there are structures adherent to the inner aspect of the anterior abdominal wall to improve abdominal entry safety.
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