Role of ultrasound in reducing complication during primary trocar insertion in laparoscopic surgery: prospective observational study

Abstract

Background: Patients presenting to Gynecology OPD at LLRM Medical College, Meerut, UP, India for benign laparoscopic surgery from June 2016 to May 2017 were included in the study. A total of 130 women completed the study of which 30 had history of previous abdominal surgery and 100 had no history of previous abdominal surgery. The ability of the visceral slide test to detect periumbilical adhesions was compared with laparoscopic detection of adhesions.Methods: Patients fulfilling inclusion and exclusion criteria and preanaesthetic clearance were subjected to office based Visceral Slide test using high frequency ultrasound probe (7.5 MHz) in the sagittal plane at the level of umbilicus. Distance between the skin and posterior rectus sheath was measured. Diagnostic accuracy of visceral slide test and mean time taken to perform the test was noted.Results: On laparoscopy 4 women had periumbilical adhesions while 24 women in the total sample had adhesions elsewhere in the abdominal cavity. The visceral slide test had a sensitivity of 75%, specificity of 98%, positive predictive value of 75% and negative predictive value of 99%. The diagnostic accuracy of the test is 97%. The median time to perform the examination was 1.69 minutes.Conclusions: The visceral slide technique was convenient and rapid to perform, and reliably identified adhesions in the periumbilical area.

Preoperative ultrasonography in the evaluation of abdominal wall adhesions

“…The frequency of adhesions in the Pfannensteil group was more in our patients compared to Brill et al and Levrant et al 2,7 In a recent study Dhama et al witnessed comparable findings of 6.7% patients developing adhesions after laparoscopy, 56.7% patients following Pfannensteil incision, 33.3% after midline infraumbilical incision and 3.3% after right paramedian incision. 8 Patients with midline incisions performed for gynecological indications had significantly more adhesions (42.08%) than all types of incisions performed for obstetric indications (21.81%), as stated in the study by Brill et al 2 However in our study, adhesions in obstetric group showed an incidence of 40% versus 29% gynecological surgery group. This difference may be attributed to greater number of laparoscopic surgeries (N=39) in gynecological surgery group.…”