Intraoperative and Postoperative Outcomes of Modified Bidirectional Intra-Umbilical Incision versus Infra-Umbilical Incision for Direct Trocar Insertion in Gynaecological Laparoscopy

Abstract

Objectives: To describe a modified curved deep bidirectional intra-umbilical vertical incision for primary trocar insertion and prospectively compare its intraoperative and postoperative outcomes with infra-umbilical incision in gynecologic laparoscopy. Methods: Between August 2019 and March 2021, 110 patients subjected to direct trocar insertion technique for laparoscopic intervention were classified into two groups. Group A comprised 55 cases of infra-umbilical incision while a modified curved longitudinal bidirectional deep intra-umbilical incision was used in group B (55 cases). Intraoperative and postoperative assessments were performed. Results: There was statistically significant increased numbers of parity, gravidity, and previous cesarean sections; and a smaller number of infertility complaints in group B. Likewise, group B expressed a statistically significant less peri-trocar CO2 leakage (46 patients, 83.6% versus 28 patients, 50.9%) and more tightness of the primary portal entry (45 patients, 81.8% versus 30 patients, 54.5%) if compared to group A throughout the whole operation. On follow-up after one month, there was a statistically significant (p-value = 0.029) decreased OSAS and PSAS in group B (10.4 ± 4.2 and 11.8 ± 4.3) i.e., better cosmoses when compared to group A (13.3 ± 5.7 and 16.0 ± 6.8) respectively. Conclusion: Performing a modified curved deep bidirectional intra-umbilical vertical incision for insertion of primary laparoscopic trocar is a simple and fast step that results in elimination of intraoperative gas leakage and trocar slippage without the need of any additional sutures. Aesthetically, it results in a better scar with satisfactory cosmoses if compared to infra-umbilical incision.
 Keywords: Laparoscopy; Trocar; Entry.