First port placement for pneumoperitoneum

ABSTRACT

To find out utility of a modified method of creating pneumoperitoneum for laparoscopic surgery. Quasi-experimental study. Ziauddin Medical University Hospital and Kutiyana Memon Hospital, Karachi from September 2007 to March 2008. The modified method for the creation of pneumoperitoneum for laparoscopic surgeries was applied to all patients. Approximately 1.2 cm vertical incision was made below the umbilicus and subcutaneous fat separated by blunt dissection till the rectus sheath visualized. A small incision approximately 5 mm was made in the full thickness of linea alba without opening the peritoneum. An artery forcep was then introduced in the peritoneum to open it. Rate of success of the procedure, time from sub umbilical incision to insertion of telescope and complication / difficulty encountered during the procedure were recorded in the operative notes and pre designed proforma. Results of the present technique was analyzed and compared with published literature in terms of visceral injury and air leak. A total of 55 patients were included in this study. Scar of previous abdominal surgery was present in 16 patients. Mean time from skin incision to insertion of telescope was 55 seconds [ranging from 35 to 95 seconds]. Trocar insertion into extra-peritoneal space occurred in 6 patients. Withdrawl and re-insertion into peritoneal space was successful in all cases except in 2[3.63%] patients in whom procedure was converted to open technique. No bowel or visceral injury occurred during the procedure. Gas leakage was not encountered during entire surgical procedure in all the patients. This modified technique for the creation of pneumoperitoneum for laparoscopic surgery is safe, quick and without the use of any specialized or disposable instruments