2198 New Laparoscopic Entry Port for Previous Surgery Cases: Jain Point

Abstract

Study Objective Laparoscopy in previous surgery cases is a challenge due to risk of encountering adhesions during the first blind trocar entry. This study demonstrates the technique, and relative benefits of a new entry point. Design It is a retrospective study undertaken at a high volume tertiary care referral center for advanced gynecological laparoscopic surgery. Setting Tertiary Care Centre Patients or Participants The total number of patients from January 2011 to March 2019. Total 6830 laparoscopic cases were done between January 2011 to March 2019. In 1948 patients there was a history of previous abdominal surgeries. Interventions Working over the years we found that post surgical adhesions are encountered usually in the midline or right side. The left side is spared as the colon adheres at the pelvic brim and stomach and spleen lie higher up at T 10 level. So we developed a point which is at L4 level and on the left side. It is at the level of umbilicus on a straight line drawn vertically upwards from a point 2.5 cm medial to the anterior superior iliac spine. We first introduce the veress needle perpendicular to the abdomen and then the 5mm telescope from this point, and optimize the 10 mm telescope entry. Jain Point port doubles up as the main working port in due course of surgery. Measurements and Main Results All of the 6830 cases were entered by the Jain Point in an identical manner. Out of these 1948 case were of previous one or multiple surgeries. Conclusion Jain Point offers an alternate safe entry point in previous surgery cases, applicable to upper, mid and lower abdominal scars. Laparoscopy in previous surgery cases is a challenge due to risk of encountering adhesions during the first blind trocar entry. This study demonstrates the technique, and relative benefits of a new entry point. It is a retrospective study undertaken at a high volume tertiary care referral center for advanced gynecological laparoscopic surgery. Tertiary Care Centre The total number of patients from January 2011 to March 2019. Total 6830 laparoscopic cases were done between January 2011 to March 2019. In 1948 patients there was a history of previous abdominal surgeries. Working over the years we found that post surgical adhesions are encountered usually in the midline or right side. The left side is spared as the colon adheres at the pelvic brim and stomach and spleen lie higher up at T 10 level. So we developed a point which is at L4 level and on the left side. It is at the level of umbilicus on a straight line drawn vertically upwards from a point 2.5 cm medial to the anterior superior iliac spine. We first introduce the veress needle perpendicular to the abdomen and then the 5mm telescope from this point, and optimize the 10 mm telescope entry. Jain Point port doubles up as the main working port in due course of surgery. All of the 6830 cases were entered by the Jain Point in an identical manner. Out of these 1948 case were of previous one or multiple surgeries. Jain Point offers an alternate safe entry point in previous surgery cases, applicable to upper, mid and lower abdominal scars.