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Rizzuto A, Bozzarello C, Andreuccetti J, Amaddeo A, Iannello AM, Sagnelli C, Cirocchi R, Cuccurullo D, Pignata G, Corcione F. Transumbilical laparoscopy for pneumoperitoneum establishment: a comprehensive multicentre evaluation affirming safety, feasibility, and a range of clinical benefits. Front Surg 2024; 11:1390038. [PMID: 38712337 PMCID: PMC11070471 DOI: 10.3389/fsurg.2024.1390038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
Introduction Transumbilical laparoscopy (TUL) has emerged as a promising technique for establishing pneumoperitoneum in laparoscopic cholecystectomy, offering potential safety, feasibility, and clinical benefits. This retrospective multicentre study aims to evaluate the efficacy and outcomes of TUL in the management of gallbladder diseases. Methods A retrospective analysis was conducted on a cohort of 2,543 patients who underwent TUL between 2011 and 2021 across various medical institutions in Italy. Data collection included demographic, clinical, intraoperative, and postoperative parameters. Standardized protocols were followed for preoperative and postoperative management. The TUL technique involved precise anatomical incision and trocar placement. Results The study demonstrated favorable outcomes associated with TUL, including a low conversion rate to open surgery (0.55%), minimal intraoperative complications (0.16%), and short hospital stays (average 2.4 days). The incidence of incisional hernias was notably low (0.4%). Comparison with existing literature revealed consistent findings and provided unique insights into the advantages of TUL. Discussion Despite limitations, such as the absence of a control group and the retrospective nature of the study, the findings contribute valuable insights to the literature. They inform surgical decision-making and advance patient care in laparoscopic cholecystectomy for gallbladder diseases. Conclusion Transumbilical laparoscopy shows promise as a safe and feasible technique for establishing pneumoperitoneum in laparoscopic cholecystectomy. The study's findings support its clinical benefits, including low conversion rates, minimal complications, and short hospital stays. Further research, including prospective studies with control groups, is warranted to validate these results and optimize patient outcomes.
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Affiliation(s)
- Antonia Rizzuto
- Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Cristina Bozzarello
- Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | | | - Angela Amaddeo
- Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | | | - Carlo Sagnelli
- Department of General, Mininvasive and Robotic Surgery, Colli Monaldi Hospital, Naples, Italy
| | - Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Diego Cuccurullo
- Department of General, Mininvasive and Robotic Surgery, Colli Monaldi Hospital, Naples, Italy
| | - Giusto Pignata
- Department of General Surgery, Civil Hospital of Brescia, Brescia, Italy
| | - Francesco Corcione
- Department of General Surgery, Federico II University Hospital, Naples, Italy
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Sano R, Oka A, Hirata E, Ochiai H. Umbilical Complications That Require Surgical Intervention after Gynecologic Laparoscopic Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5391. [PMID: 37964921 PMCID: PMC10642900 DOI: 10.1097/gox.0000000000005391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/21/2023] [Indexed: 11/16/2023]
Abstract
Background In laparoscopic surgery, the trocar is often inserted through the umbilicus because of the ease of insertion and inconspicuous postoperative scar formation. However, postoperative complications that require plastic surgical intervention may occur to the umbilicus. Methods We reviewed 14 patients who received plastic surgery for umbilical issues following gynecologic laparoscopic surgery in our department from January 2015 to September 2021. Results Most complications requiring umbilical surgery post gynecologic laparoscopic surgery include local infections, scar contractures, ectopic endometriosis, and umbilical necrosis. Mass resection and umbilical formation procedures were performed under general or local anesthesia. After a follow-up period of 6 months following surgery, no incidences of tumor development or recurrence of infection were seen, and the hypertrophic scar at the wound site gradually healed after the complete removal of the tumor and adequate suturing. Pathologically, 90% of the cases with keloid-like collagen disorder had concomitant inflammatory diseases such as epidermal cysts and abscesses. Conclusions The majority of umbilical complications associated with laparoscopic surgery were predicted to be due to implantation of epithelial and tumor components during laparoscopic surgery and delayed postoperative inflammation. Therefore, it is necessary to educate surgeons about general measures of local infection control and careful surgical manipulation to prevent umbilical problems associated with laparoscopic surgery.
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Affiliation(s)
- Risa Sano
- From the Department of Plastic and Reconstructive Surgery, Keio University Hospital, Tokyo, Japan
- Department of Plastic and Reconstructive Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Aiko Oka
- Department of Plastic and Reconstructive Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Eri Hirata
- Department of Plastic and Reconstructive Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Hiroko Ochiai
- Department of Plastic and Reconstructive Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
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Kurobe M, Sugihara T, Harada A, Kaji S, Uchida G, Kanamori D, Baba Y, Hiramatsu T, Ohashi S, Otsuka M. The Comparison of Postoperative Umbilical Port Site-Related Complications Between Transumbilical and Periumbilical Incision After Laparoscopic Surgery in Children. J Laparoendosc Adv Surg Tech A 2023; 33:807-813. [PMID: 37093029 DOI: 10.1089/lap.2022.0581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
Introduction: No studies have directly compared postoperative umbilical port site (UPS)-related complications between transumbilical and periumbilical incisions (TUI and PUI) after laparoscopic surgery in children. Patients and Methods: We conducted a retrospective review of 324 children of ≤15 years of age who underwent laparoscopic repair (LR) for inguinal hernia, via either a TUI or PUI, between 2010 and 2020. UPS-related complications, such as wound infection and umbilical deformity, were compared between TUI and PUI. We also investigated the risk factors for the development of UPS-related complications after LR. Results: TUIs and PUIs were used for 228 and 96 children, respectively. The incidence rates of postoperative wound infection and umbilical deformity in the PUI group were higher in comparison to the TUI group; although not to a statistically significant extent (7.3% versus 5.3%, P = .451, 6.3% versus 4.8%, P = .593). One case of incisional hernia at the UPS was seen in the TUI group. In the univariate analysis, sex, age, weight for age Z-score, nutrition status, insertion and closure time, total operative time, American Society of Anesthesiologists score, blood loss, and comorbidities were not significantly associated with the development of UPS-related complications after LR. Conclusion: The incidence of UPS-related complications in TUI and PUI was not significantly different. Due to the low incidence of UPS-related complications, it was difficult to draw conclusions regarding contributing factors; however, meticulous care should be taken to avoid UPS-related complications when closing the UPS (Ethical approval No. 2019-24).
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Affiliation(s)
- Masashi Kurobe
- Department of Pediatric Surgery and Kawaguchi Municipal Medical Center, Kawaguchi, Japan
- Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Tetsuro Sugihara
- Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Atsushi Harada
- Department of Pediatric Surgery and Kawaguchi Municipal Medical Center, Kawaguchi, Japan
| | - Sayuri Kaji
- Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Goki Uchida
- Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Daisuke Kanamori
- Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Yuji Baba
- Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Tomomasa Hiramatsu
- Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Shinsuke Ohashi
- Division of Pediatric Surgery, Department of Surgery, The Jikei University, School of Medicine, Tokyo, Japan
| | - Masahiko Otsuka
- Department of Surgery, Kawaguchi Municipal Medical Center, Kawaguchi, Japan
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Lin CY, Li CC, Ke HL, Wu WJ, Chou YH, Wen SC. Safety and efficacy of laparoendoscopic single-site donor nephrectomy: A comparison of the transperitoneal and retroperitoneal approaches. UROLOGICAL SCIENCE 2022. [DOI: 10.4103/uros.uros_146_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Modified Intraumbilical Versus Infraumbilical Entry Method at Laparoscopy: A Cohort Study. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2021; 32:21-27. [PMID: 34420006 DOI: 10.1097/sle.0000000000000983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/29/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is no consensus on the optimal laparoscopic entry method. Whether a transumbilical or periumbilical incision is beneficial for the initial peritoneal access has been debated. These 2 methods have their own advocates, since each has its own benefits and disadvantages. Furthermore, the lack of consensus extends to the type of entry technique [Hasson, Veress needle (VN), direct trocar]. We have conducted a study comparing a modified intraumbilical technique (MIT), a novel method that combines a VN insertion through a modified direct-trocar access, with the standard infraumbilical VN technique. Our aim is to determine which technique is a better route for the initial umbilical trocar. MATERIALS AND METHODS A retrospective cohort study of 406 patients from a prospectively maintained database has been performed. Two cohorts of cases have been analyzed (VN=198; MIT=208). Primary outcomes were intraoperative access-related events, entry failure, and long-term wound complications. Clinical follow-up was performed at 1 and 6 months and yearly thereafter. RESULTS Subcutaneous emphysema, extraperitoneal insufflation, and difficult entry (>2 VN insertions) occurred more frequently in the VN group (P=0.011, 0.023, and 0.023, respectively). There were 5 (2.52%) failed entries in the VN group and none in the MIT group (P=0.085). Regarding postoperative complications, seroma of the wound occurred more frequently in the VN group (P=0.033). At a mean follow-up of 18.4 months, 13 (3.20%) trocar-site hernias were detected, equally distributed among both groups. CONCLUSIONS MIT eliminates the risk of failed entries and some complications associated with the VN technique without an increase in umbilical wound infection and facilitates a proper closure of the umbilical incision to secure a low trocar-site hernia rate. Halfway between open and closed techniques for laparoscopic entry, MIT is a safe and feasible procedure that embodies the advantages of both methods and may constitute an advantageous alternative to the infraumbilical VN entry approach.
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MISCIA ME, RICCIO A, LISI G, FUSILLO M, LELLI CHIESA P. Subumbilical versus transumbilical laparoscopic assisted appendectomy in children: a caregivers-centered cosmetic satisfaction evaluation. Chirurgia (Bucur) 2021. [DOI: 10.23736/s0394-9508.20.05103-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Shih SL, Chen BH, Tam KW. Transumbilical versus periumbilical incision for laparoscopic surgery: A meta-analysis. Am J Surg 2020; 220:1592-1598. [PMID: 32370874 DOI: 10.1016/j.amjsurg.2020.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Whether a transumbilical or periumbilical incision is beneficial for the initial peritoneal access in laparoscopic abdominal surgery has been debated. Our aim is to determine whether a transumbilical or periumbilical incision is a better route for the initial umbilical trocar. METHODS PubMed, Embase, and Cochrane Library databases were searched for articles published before March 2020. The meta-analysis calculated the pooled effect size by using a random effects model. RESULTS Five trials involving 783 patients were reviewed. The transumbilical group significantly reduced operation time (mean difference: -7.73; 95% confidence interval: -13.10 to -2.35) when compared to the periumbilical group. The length of hospital stay, mean pain scores on operation day and postoperation day 1 did not differ significantly between the two groups. Moreover, the incidence of surgical site infection, cosmetic satisfaction, and complication rate did not differ significantly between groups. CONCLUSION A transumbilical incision is better than a periumbilical incision for laparoscopic surgery as it saves operation time. Hence, we suggest transumbilical incisions for the initial peritoneal access in laparoscopic abdominal surgery.
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Affiliation(s)
- Shen-Liang Shih
- Cancer Center, Yuan's General Hospital, Kaohsiung, Taiwan; Department of Health Business Administration, Meiho University, Pingtung, Taiwan
| | - Bo-Han Chen
- Department of General Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
| | - Ka-Wai Tam
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Bouffard-Cloutier A, Paré A, McFadden N. Periumbilical vs transumbilical laparoscopic incision: A patients' satisfaction-centered randomised trial. Int J Surg 2017; 43:86-91. [PMID: 28552811 DOI: 10.1016/j.ijsu.2017.05.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 05/18/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND While studies suggested that transumbilical incisions (TUI) incur better postoperative cosmetic satisfaction scores (CSS) and shorter operative time (OT) than periumbilical incisions (PUI) during general surgery laparoscopic interventions, others did not. Concerns have been raised toward the potential negative impact of TUI on the incidence of surgical site infection (SSI) but this issue is under documented. METHODS A controlled trial was conducted between August 2014 and August 2015 in our hospital. Individuals aged 18-70 undergoing a laparoscopic rectopexy, cholecystectomy, appendectomy or proctocolectomy were considered. Patients were randomized in two groups (PUI or TUI) following a 1:1 allocation ratio. Participants with a body mass index >40, with a history of abdominal surgery, undergoing co-operations, requesting a specific incision or converted to open surgery were excluded. RESULTS Among the 56 randomized patients, 50 (27 PUI vs 23 PUI) produced analyzable data. There were no significant difference between the characteristics of both groups. CSS evolution (pre-op vs 1 month post-op), SSI incidence and OT were also comparable. Only 28% of participants valued the appearance of their umbilicus prior to intervention. Those who did had a significantly worst CSS evolution (OR -1.7; IC95-2.6/-0.72, p = 0.001). Higher preoperative CSS was also a predictor of postoperative CSS decline (OR -0.4; IC95-0.6/-0.2, p = 0.001). CONCLUSIONS SUI and TUI were similar for all tested outcomes. Among the participants, the minority of patients who valued the appearance of their umbilicus and those with a high preoperative CSS were particularly prone to postoperative CSS decline.
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Affiliation(s)
- Audrey Bouffard-Cloutier
- Department of Surgery, Division of General Surgery, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Alex Paré
- Department of Surgery, Division of General Surgery, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Nathalie McFadden
- Department of Surgery, Division of General Surgery, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
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