Teres lift-up technique: A case-control study for an alternative route for laparoscopic entry in gynecologic and oncologic surgery

Abstract

Abstract Objective Laparoscopic surgery is the favored method for the surgical treatment of gynecologic diseases and malignancies. We havedefined an anatomic landmark-based, easy-to-perform, novel opening laparoscopic-entry technique named the ligamentum teres lift-up technique (TLU) that can be used in obese or normal-weight patients to tackle the risks of the closed laparoscopic entry technique, namely, Veress needle entry (VNE). Study Design In this case-control study, the patients were randomly allocated to either the TLU group (n = 36) or the VNE group (n = 36) in a 1:1 ratio. The patients were tiered according to their BMI as follows: BMI between 20-25 (average weight), 25-30 (overweight), 30-35 (class I obesity), and 35-40 (class II obesity). Both laparoscopic access techniques were compared according to the entry time, vascular or visceral injuries, insufflation failures, trocar-related complications, and omental damage. Results The TLU group had a considerably shorter entry time than the VNE group (74,43±21,45 sec versus 192,73±37,93 sec; p <.001). Only one failed insufflation occurred in the VNE group (p =.32); however, that patient was successfully insufflated with the TLU technique. Only one intestinal injury was seen in the VNE group, encountered during trocar site closure (p =.32). The subgroup analyses of the TLU and VNE groups based on BMI tiers revealed a continuation of the statistical significance of entry time between BMI-matched groups. Conclusion The current study proves that the novel TLU technique provides an alternative, validated, and rapid access to the abdominal cavity in normal-weight and obese patients. This new approach offers an easy-to-teach and easy-to-perform technique for surgical mentors and residents in gynecologic and oncologic surgeries.