Reduced Port Surgery using an umbilical Zigzag incision in gastrointestinal surgery

Yujo Kawashita, MD, Takashi Ueda, MD, Naonori Hazeyama, MD, Nobuhiro Shin, MD. Fukuoka Seisyukai Hospital

Introduction: Reduced port surgery (RPS) is an increasingly recognized way of conducting laparoscopic surgery in order to balance the safety and feasibility of single incision laparoscopic surgery. However, it is still technically demanding procedures and difficult to be standardized mainly due to its potential conflict of the surgical instruments.  To address this issue, a novel concept of an umbilical Zigzag skin incision was created to hide the scar inside the umbilicus while securing enough working space. In this study, we retrospectively analyzed our data of RPS through the umbilical Zigzag incision in patients with gastrointestinal surgery.

Method: A total of 47 patients underwent RPS with this method: 3 partial hepatectomies, 2 distal pancreatectomies, 7 gastrectomies, 22 colectomies and 13 cholecystectomies.  A Zigzag shaped incision was established right on the umbilicus. Then, a GelPOINT double-ring wound retractor or Oval-shaped EZ access port was inserted through the incision, as an access port which enlarged the diameter of the fascial openings to 3-6 cm. Standard or fine needle laparoscopic instruments were placed into the abdominal cavity. Once the laparoscope, grasper, and dissector are set, the overall procedures are similar to the standard laparoscopic surgery.

Results: RPS through an umbilical Zigzag skin incision was successfully completed in all patients without conversion to open surgery. Additional trocars were inserted as necessary. On average, operative time was 8.5-27.8% longer than that of conventional method. The blood loss, and the mean postoperative hospital stay were comparable to conventional procedures.  Postoperative complications included 1 seroma, 1 SSI without the need of reoperation. Cosmetic satisfaction was excellent in almost all cases.

Conclusion: We established a new approach of RPS through an umbilical Zigzag skin incision. We believe that this approach will widen the application of reduced port surgery in many fields of surgery by overcoming its technical difficulties, while maintaining favorable cosmetic benefits. 

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