Intraoperative and Postoperative Outcomes of Modified Bidirectional Intra-Umbilical Incision versus Infra-Umbilical Incision for Direct Trocar Insertion in Gynaecological Laparoscopy: A randomised controlled trial.

Q3 Medicine
Sultan Qaboos University Medical Journal Pub Date : 2023-11-01 Epub Date: 2023-11-30 DOI:10.18295/squmj.5.2023.027
Atef Darwish, Mohammad Tawfik, Amal Gaflan, Dina Darwish
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引用次数: 0

Abstract

Objectives: This study aimed to describe a modified, curved, deep, bidirectional, intra-umbilical, vertical incision for primary trocar insertion and prospectively compare its intraoperative and postoperative outcomes with an infra-umbilical incision in gynaecologic laparoscopy.

Methods: Between August 2019 and March 2021, 110 patients subjected to the direct trocar insertion technique for laparoscopic intervention were classified into two groups. Group A comprised 55 cases of infra-umbilical incision, whereas group B comprised 55 cases of a modified, curved, longitudinal, deep, bidirectional, intra-umbilical incision. Afterwards, intraoperative and postoperative assessments were performed.

Results: The increase in the numbers of parity, gravidity and previous caesarean sections was found to be statistically significant; a smaller number of infertility complaints were observed in group B. Similarly, group B expressed a statistically significant less peri-trocar CO2 leakage (46 [83.6%] patients versus 28 [50.9%] patients) and more tightness of the primary portal entry (45 [81.8%] patients versus 30 [54.5%] patients) when compared to group A throughout the whole operation. After a one-month follow-up, a statistically significant (P = 0.029) decrease in the Observer Scar Assessment Scale and Patient Scar Assessment Scale scores in group B (10.4 ± 4.2 and 11.8 ± 4.3, respectively), demonstrating better cosmoses when compared to group A (13.3 ± 5.7 and 16.0 ± 6.8, respectively).

Conclusion: Performing a modified, curved, deep, bidirectional, intra-umbilical, vertical incision for the insertion of a primary laparoscopic trocar (i.e. Darwish laparoscopic entry) is a simple and fast step that results in the elimination of intraoperative gas leakage and trocar slippage without the need for any additional sutures. Aesthetically, it results in a better scar with satisfactory cosmoses when compared to an infra-umbilical incision.

改良双向脐内切口与脐下切口在妇科腹腔镜下直接插入套管的术中和术后效果
目的:介绍一种改良的弧形深双向脐内垂直切口用于一期套管针置入,并与妇科腹腔镜脐下切口进行术中、术后效果的前瞻性比较。方法:2019年8月至2021年3月,将110例采用直接套管针插入技术进行腹腔镜介入治疗的患者分为两组。A组55例采用脐下切口,B组55例采用改良弯纵双向脐内深切口。进行术中及术后评估。结果:产次、妊娠和既往剖宫产次数均有统计学意义的增加;同样,B组在整个手术过程中表现出更少的套管针周围CO2泄漏(46例,83.6%对28例,50.9%)和更紧密的主要门静脉入口(45例,81.8%对30例,54.5%),与a组相比具有统计学意义。1个月后随访,B组OSAS和PSAS下降(10.4±4.2和11.8±4.3),较a组(13.3±5.7和16.0±6.8)有统计学意义(p值= 0.029)。结论:采用改良的弧形深双向脐内垂直切口置入腹腔镜一期套管针是一种简单快捷的方法,可消除术中气体泄漏和套管针滑脱,无需再进行缝合。从美学上讲,与脐下切口相比,它的疤痕效果更好,外形令人满意。关键词:腹腔镜检查;套管针;条目。
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来源期刊
CiteScore
2.00
自引率
0.00%
发文量
86
审稿时长
7 weeks
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