A New Method for Laparoscopic Port Insertion Using Exposure of the Rectus Sheath Fascia and Z-type Sutures

Shin, Dong Hoon

Abstract

PURPOSE
Access to the peritoneal cavity requires a pneumoperitoneum for laparoscopic procedures. Safe insertion of the first port during laparoscopic surgery has always been problematic, from the early use of the Veress needle to the open Hasson technique. Many procedures must be done blindly. The blind insertion of a Veress needle or first trocar, to create the pneumoperitoneum, has been shown to cause vascular and visceral injuries. To reduce the risks associated with peritoneal entry, many surgeons prefer an open- access technique, similar to the Hassson method. The aim of this study was to assess the safety of peritoneal entry and avoidance of vascular and visceral injuries with a new technique.
METHODS
In a series of 385 patients, a modified new method of laparoscopic port insertion using exposure of the rectus sheath fascia and Z-type sutures was performed to obtain a pneumoperitoneum for laparoscopic cholecystectomy from 2004 to 2008, at the Gospel Hospital, Kosin University College of Medicine.
RESULTS
There were no visceral or vascular complications among the 385 patients that had laparoscopy using this technique.
CONCLUSION
This technique was safe and effective for laparoscopic cholecystectomy procedures and should be considered an option to reduce entry injuries during laparoscopic surgery involving the peritoneal cavity.