Abstract
Background: Intraperitoneal access in laparoscopic surgery is the first and most important step to start a procedure. Many methods have been described in literature for the same. We share our experience of umbilical tube technique using a vertical infra umbilical or supra umbilical incision for the better cosmetic result.
 Methods: This study is a retrospective study of laparoscopy performed for various indications. Umbilical tube technique was performed. In 1532 cases performed from July2016to January 2019. A vertical incision was used instead of a commonly performed curve incision to access the umbilical tube. A vertical incision is again taken after exposing the junction of rectus sheath and umbilical tube. Vertical incision is again taken over the tube to gain access to peritoneal cavity. The closure is done in a similar way with skin closed in subcuticular fashion. No Institutional Review Board (IRB) approval was required for this paper.
 Result: The technique is found to be safe, can be performed with technical ease as anatomy is well defined, good cosmesis is achieved. The longest follow up is for a period of one year. No incidence of port site hernia or infection was seen.
 Conclusion: The umbilical tube technique using a vertical incision is found to be safe and effective, can be reproduced with technical ease. In our opinion this method can be considered as a standard approach to intraperitoneal access.
 Keywords: umbilical tube, intraperitoneal access, port site infection, port site hernia. Laparoscopy.
Highlights
Intraperitoneal (IP) access is the first and important step in any laparoscopic surgical procedure[1]
The supra umbilical incision was taken for TLH and Laparoscopic Appendectomy whereas the infra umbilical incision was taken for Laparoscopic Fundoplication and Laparoscopic Cholecystectomy
During the study we have found zero complication rates in our parameters of Port site infection, Port site Hernia, Visceral and Vascular injuries with the above results no statistical analysis has been applied
Summary
Intraperitoneal (IP) access is the first and important step in any laparoscopic surgical procedure[1]. The importance of the application of counter traction directly at the point of insertion has been described in literature [4] This method allows the penetration under the direct vision with minimal controlled axial force and without the requirement of fascial sutures or other cumbersome aspects of the traditional open technique[5]. Conclusion: The umbilical tube technique using a vertical incision is found to be safe and effective, can be reproduced with technical ease. In our opinion this method can be considered as a standard approach to intraperitoneal access.
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