8653 Technique for Cosmetic Closure of the Umbilicus during Single Site Laparoscopy

Abstract

<h3>Study Objective</h3> This presentation demonstrates a novel technique to ensure cosmetic closure of the umbilicus during single-site laparoscopy. Single-site laparoscopy has grown in popularity as it leaves a single abdominal scar that can be hidden within the umbilicus. However, usual closure technique is often not sufficient to optimize the appearance for patients. <h3>Design</h3> Instructional Video. <h3>Setting</h3> Tertiary care center outside of a major city in the United States. <h3>Patients or Participants</h3> Patients presenting for single-site laparoscopic gynecologic surgery. <h3>Interventions</h3> Abdominal entry is performed using Hassan technique through a single vertical skin incision extending just superior and inferior to the umbilical edges. After the procedure is complete, the fascia is closed with a single running 0 polyglactin suture. The skin is undermined to create bilateral flaps and redundant tissue is trimmed. The fascia is grasped by a Kocher clamp and two throws of a 2-0 polyglactin suture on a non-cutting needle are driven through one skin edge, through the fascia and through the opposite skin edge to recreate the umbilical base. The sutures are tied down in sequence, and the remaining skin is reapproximated with several interrupted, inverted 3-0 polyglactin sutures on a cutting needle. Using this method, the final incision is under 3 centimeters and the natural depth of the umbilicus is recreated. The incision is cleaned and dressed with petroleum gauze, an eye patch, and an occlusive dressing with excess air removed with an empty syringe. <h3>Measurements and Main Results</h3> At 6 weeks after surgery the incision is hardly visible, and the reconstructed umbilicus resembles its natural pre-operative appearance. <h3>Conclusion</h3> When single-site laparoscopy is performed, cosmesis can be optimized by using a specialized technique to reconstruct the umbilicus.