An Alternate Non Umbilical Entry Port for Laparoscopic Entry in Thin Patients

Abstract

Study Objective To study the feasibility of a non umbilical first blind entry port in patients with BMI less than 18.5. Design Retrospective study assessing the laparoscopic entry in patients operated during the study period from January 2011 to December 2019. Setting Patients were operated under general anesthesia. Patients or Participants Selection criteria was patients of BMI less than 18. Out of the total 7398 patients in which laparoscopic entry was done by the left lateral port,398 patients met the selection criteria.70 thin patients had history of previous surgeries. Interventions In the study group veress needle and first primary port was introduced through a left lateral paraumbilical port about 10 cm lateral to the umbilicus. This point is located on a straight line drawn 2.5cm medial to the ASIS at the level of umbilicus. During veress needle and primary 5mm trocar entry the abdominal wall is not lifted up and veress needle insertion is done in one straight vertical line without changing the direction to 45 degree. Under vision of first 5mm telescope the 10mm port and then accessory ports are inserted. This port placement is aimed at avoiding the major vessel injury. 5 mm port also optimizes the 10mm telescope port entry as is needed in cases with large masses and cases with previous surgery. This port then continues as main ergonomic ipsilateral working port. Measurements and Main Results All 398 cases were entered safely without any major complication or conversion to laparotomy. First blind entry was well delineated due to good muscle tone in thin patients. No long term sequelae noted. Conclusion Left lateral paraumbilical port is a safe alternate first blind non - umbilical port in thin patients with advantage of avoiding major vascular injury and avoiding adhesions in previous surgery cases.