Palmer's Point Versus The Umbilicus As Routine Primary Entry Site In Gynecologic Laparoscopy

Zagazig University

Status: Unknown

Conditions: Gynecologic Disease

Treatments: Procedure: laparoscopy entry policy

Study type: Interventional

Funder types: Other

Identifiers

NCT04216979

5806-15-12-2019

Details and patient eligibility

About

we will compare the classic method of using the umbilicus as the primary entry site in gynecological laparoscopy with Palmar's point

Full description

All these cases will undergo:

1. History taking Patients are randomly arranged in 2 groups Group (A):- Palmer's point is the primary entry site. The stomach will be emptied of secretions and air following endotracheal intubation. (This is most easily performed using a nasogastric tube.) The left upper quadrant will be inspected for scars and the upper abdomen palpated for hepatomegaly or splenomegaly. A 10-mm incision will be made over Palmer's point. Veress needle first will be used for insufflation and tests of safety will be considered.

A 10-mm port will be held vertically and the layers observed via a 10-mm laparoscope. A gentle rotating action in a vertical direction was used to allow the bladeless tip to separate the tissues.

The layers of the abdominal wall seen at Palmer's point are as follows:

• skin,
• subcutaneous fat,
• external oblique aponeurosis,
• internal oblique aponeurosis,
• transversalis muscle fibres,
• (sometimes) extraperitoneal fat,
• peritoneum. Once the peritoneum will be breached, the introducer will be carefully removed from the port. The laparoscope will be then reintroduced.

An extra 360° check was then performed to exclude a through-and-through bowel injury. The umbilicus was then inspected and any adhesions cleared using one or more 5-mm ports inserted under direct vision. At the end of the operation, the skin was closed using a single subcuticular suture Group (B):- The umbilicus is the primary entry site. First of all, the umbilicus is well cleaned with a piece of gauze with betadine or alcohol then small incision is done (10mm) in the umbilicus, veress needle is then inserted and tests of safety of intraperotineal insufflation are considered. 10 mm port is then introduced with gentle rotating action in a vertical direction to allow the bladeless tip to separate the tissues.

The layers of the abdominal wall seen at Palmer's point are as follows:

• skin
• linea alba
• peritoneum. Once the peritoneum is breached, the trocar will be carefully removed from the port. The laparoscope will then reintroduced.

An extra 360° check was then performed to exclude a through-and-through bowel injury. At the end of the operation, the skin will be closed using a single subcuticular suture

Enrollment: 96 estimated patients

Sex: Female

Ages: 10 to 60 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Patients listed for diagnostic or operative laparoscopy.

Exclusion criteria

• • Splenomegaly

  • Hepatomegaly
  • previous left upper quadrant surgery.
  • midline laparotomy
  • umbilical surgery
  • presence of umbilical hernia

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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96 participants in 3 patient groups

randomization

Experimental group

Description:

Patients are randomly arranged in 2 groups Group (A):- Palmer's point is the primary entry site. Group (B):- The umbilicus is the primary entry site.

Treatment:

Procedure: laparoscopy entry policy

group A

Experimental group

Description:

these are the patient with palmars point as primary entry site

Treatment:

Procedure: laparoscopy entry policy

group B

Experimental group

Description:

these are the patient with umbilicus as primary entry site

Treatment:

Procedure: laparoscopy entry policy