Is there any difference between the distances created by towel clamp lifting and towel clamp plus manual lifting of the anterior abdominal wall for direct trocar entry in laparoscopic gynecologic surgery? A prospective interventional study.

Taner A Usta,Ulviye Hanlı,Evrim Ebru Kovalak,Tolga Karacan,M Murat Naki

doi:10.4274/jtgga.2016.0203

Taner A Usta, Ulviye Hanlı + Show 3 more

Open Access

https://doi.org/10.4274/jtgga.2016.0203

Copy DOI

Abstract

Objective:Most surgeons prefer to perform anterior abdominal wall lifting during abdominal entry to avoid damage to intestines or main vessels. Anterior abdominal wall lifting is assumed to prevent vital organ injuries by creating an adequate distance prior to entry into the peritoneal cavity. In this study, we compared the distance created for trocar entry into the peritoneal cavity with towel clamp lifting and towel clamp plus manual elevation of the anterior abdominal wall.Material and Methods:Forty patients who underwent various laparoscopic procedures were enrolled. The study was performed in two steps: first the anterior abdominal wall was lifted using towel clamps (TC group), next the anterior abdominal wall was lifted via maximal manual elevation from the lower abdomen in addition to towel clamps (TCM group). The insertion distance of a plastic ruler into the abdomen was measured from the parietal peritoneum to the intra-abdominal structure in both groups.Results:There was a statistically significant difference between the two groups (TC group 3.9±1.5 cm vs. TCM group 4.5±1.5 cm, p<0.001). Correlation analysis of the relationship of distance with BMI in the study groups revealed a strong negative linear correlation [TC group vs. body mass index (BMI); r=-0.719, p<0.001 and TCM group vs. BMI, r=-0.749, p<0.001]. Correlation analysis of the relationship between the study groups and parity number revealed a weak negative linear correlation (TC group vs. parity number, r=-0.071, p=0.76 and the TCM group vs. parity number, p=0.61), which did not reach statistical significance.Conclusion:The recruitment of both towel clamps and manual elevation in anterior abdominal wall lifting provides significantly greater distance for trocar entry in laparoscopic surgery.

Highlights

Complications that arise during abdominal cavity entry constitute about 50% of all complications encountered in laparoscopic surgery
Direct trocar insertion, the Hasson technique, and visual trocar systems might be used for abdominal entry to create pneumoperitoneum
The mean distance achieved during anterior abdominal wall lifting was 3.9±1.5 cm in the towel clamps (TC) group, and 4.5±1.5 cm in the TCM group

Summary

Introduction

Complications that arise during abdominal cavity entry constitute about 50% of all complications encountered in laparoscopic surgery. The conventional method of creating pneumoperitoneum in closed entry techniques entails blindly advancing the Veress needle or trocar from the umbilicus into the peritoneal cavity during abdominal wall lifting. Abdominal wall lifting might be performed manually and/or with the help of towel clamps (TC). The main goal of the procedure is to avoid intestinal and vascular injuries, and increase skin resistance to facilitate subcutaneous tissue perforation during abdominal entry [1,2]. 175 Anterior abdominal wall elevation in laparoscopic gynecologic surgery organ injuries by creating an adequate distance prior to entry into the peritoneal cavity. We aimed to determine whether the additional manual upwards lifting of the anterior abdominal wall prior to laparoscopic entry provided any significant increase in the distance compared with the use of towel clamps alone. We compared the relationship of both procedures with body mass index (BMI) and parity number

Material and Methods

Results

Discussion