Author(s): Amish Wani, Ashwani Kumar Dalal, Usha Rani Dalal, Hari Rathi, Komal, Akhil Garg
BACKGROUND Transumbilical 10 mm camera port insertion through the umbilical fossa is enthusiastically practiced for laparoscopic cholecystectomy throughout the world considering its advantages of hidden scar and better cosmetic outcome. Direct trocar insertion and Veress needle insufflation are very commonly used for first trocar insertion. In the present study, we have compared the clinical outcome of transumbilical versus infraumbilical approach by a 5 mm camera port instead of the traditional 10 mm, by direct trocar method in 3 port laparoscopic cholecystectomy. METHODS A randomised prospective study was conducted in a unit in Department of General Surgery, Government Medical College and Hospital, Chandigarh, India. A modified method was performed on 200 patients with 100 patients each in transumbilical and infraumbilical group from January 2017 to April 2018 with 3 months of follow up. RESULTS In the study, it was found that the transumbilical approach for creation of pneumoperitoneum by direct trocar with 5mm camera port had statistically better results than the infraumbilical approach in terms of the time required for the successful start of creation of pneumoperitoneum, number of attempts and better cosmesis and therefore transumbilical approach is an effective alternative to infraumbilical approach for using 5 mm camera port by direct technique for creation of pneumoperitoneum. CONCLUSIONS Following strict aseptic technique and decreasing the size of the camera port to 5 mm, transumbilical is a promising better alternative method for first trocar entry with no increased risk of port-site infection or a hernia and with the added advantage of better cosmetic outcome and patient satisfaction.