Comparison of three umbilical entry sites for intraperitoneal access by the direct trocar insertion technique: a randomized pilot study.

Abstract

The most effective methods and entry sites for laparoscopic surgery remain a subject of ongoing investigation and discussion. The purpose of the study was to analyze and compare three umbilical entry sites for intraperitoneal access using the direct trocar insertion technique. A randomized pilot study was conducted between March 2021 and January 2023, involving women eligible for laparoscopic gynecological surgery. The women were allocated to one of three equally sized groups based on trocar entry points: subumbilical, supraumbilical, or umbilical. Success and failure rates of trocar entry, factors influencing success or failure, and early and late complications were systematically evaluated and compared across groups. A total of 243 patients, with a mean age of 32.93±8.33 years, were included in three groups of 81 each. Trocar entry success rates were 97.5%, 89.2%, and 89.5% in the supraumbilical, umbilical, and subumbilical groups, respectively (p>0.05). Failed trocar entry was significantly associated with age, gravidity, body mass index (BMI), waist circumference, hip circumference, and abdominal subcutaneous fat thickness (p<0.001). Regression analysis revealed that, in the subumbilical group, higher gravidity [odds ratios (OR): 0.390, 95% confidence interval (CI): 0.174-0.872, p=0.022) and greater abdominal subcutaneous fat thickness (OR: 0.090, 95% CI: 0.019-0.431, p=0.03) were associated with lower odds of successful trocar entry. In contrast, in the umbilical group, a higher waist circumference was associated with lower odds of successful trocar entry (OR: 0.673, 95% CI: 0.494-0.918, p=0.012). None of the covariates were significant in the supraumbilical group. The study highlighted the importance of selecting the appropriate trocar entry site in laparoscopic gynecological surgery. Surgeons should consider factors such as age, gravidity, BMI, waist circumference, hip circumference, and abdominal subcutaneous fat thickness, as these factors significantly influence the success of trocar entry.