Role of ultrasound in reducing complication during primary trocar insertion in laparoscopic surgery: prospective observational study

Authors

  • Vandana Dhama Department of Obstetrics and Gynaecology, Lala Lajpat Rai Medical College and Sardar Vallabh Bhai Patel Hospital, Meerut, Uttar Pradesh, India
  • Vipin Dhama Department of Anaesthesia, Lala Lajpat Rai Medical College and Sardar Vallabh Bhai Patel Hospital, Meerut, Uttar Pradesh, India
  • Rachna Chaudhary Department of Obstetrics and Gynaecology, Lala Lajpat Rai Medical College and Sardar Vallabh Bhai Patel Hospital, Meerut, Uttar Pradesh, India
  • Shakun Singh Department of Obstetrics and Gynaecology, Lala Lajpat Rai Medical College and Sardar Vallabh Bhai Patel Hospital, Meerut, Uttar Pradesh, India
  • Saba Aafrin Department of Obstetrics and Gynaecology, Lala Lajpat Rai Medical College and Sardar Vallabh Bhai Patel Hospital, Meerut, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20182875

Keywords:

Periumbilical adhesion, Primary trocar insertion, Visceral slide test

Abstract

Background: Patients presenting to Gynecology OPD at LLRM Medical College, Meerut, UP, India for benign laparoscopic surgery from June 2016 to May 2017 were included in the study. A total of 130 women completed the study of which 30 had history of previous abdominal surgery and 100 had no history of previous abdominal surgery. The ability of the visceral slide test to detect periumbilical adhesions was compared with laparoscopic detection of adhesions.

Methods: Patients fulfilling inclusion and exclusion criteria and preanaesthetic clearance were subjected to office based Visceral Slide test using high frequency ultrasound probe (7.5 MHz) in the sagittal plane at the level of umbilicus. Distance between the skin and posterior rectus sheath was measured. Diagnostic accuracy of visceral slide test and mean time taken to perform the test was noted.

Results: On laparoscopy 4 women had periumbilical adhesions while 24 women in the total sample had adhesions elsewhere in the abdominal cavity. The visceral slide test had a sensitivity of 75%, specificity of 98%, positive predictive value of 75% and negative predictive value of 99%. The diagnostic accuracy of the test is 97%. The median time to perform the examination was 1.69 minutes.

Conclusions: The visceral slide technique was convenient and rapid to perform, and reliably identified adhesions in the periumbilical area.

References

Chapron C, Fauconnier A, Goffinet F, Bréart G, Dubuisson JB. Laparoscopic surgery is not inherently dangerous for patients presenting with benign gynecologic pathology: results of a meta analysis. Hum Reprod. 2002;17:1334-42.

Champault G, Cazacu F, Taffinder N. Serious trocar accidents in laparoscopic surgery: a French survey of 103,852 operations. Surg Laparosc Endosc. 1996;6:367-70.

Chapron CM, Pierre F, Lacroix S, Querleu D, Lansac J, Dubuisson JB. Major vascular injuries during gynecologic laparoscopy. J Am Coll Surg. 1997;185:461-5.

Palmer R. Safety in laparoscopy. J Reprod Med. 1974;13:1-5

Jansen FW, Kolkman W, Bakkum EA, de Kroon CD, Trimbos-Kemper TC, Trimbos JB. Complications of laparoscopy: an inquiry about closed versus open-entry technique. Am J Obstet Gynecol. 2004;190:634-8.

Sigel B, Golub RM, Loiacono LA, Parsons RE, Kodama I, Machi J, et al. Technique of ultrasonic detection and mapping of abdominal wall adhesions. Surg Endosc. 1991;5:161-5.

Lee M, Kim HS, Chung HH, Kim J-W, Park NH, Song YS. Prediction of intra-abdominal adhesions using the visceral slide test: A prospective observational study. European J Obstet Gynecol Reprod Biol. 2017;213:22-5.

Postoperative adhesion development after operative laparoscopy: evaluation at early second-look procedures. Operative Laparoscopy Study Group. Fertil Steril. 1991;55:700-4.

Lee CL, Huang KG, Jain S, Wang CJ, Yen CF, Soong YK. A new portal for gynecologic laparoscopy. J Am Assoc Gynecol Laparosc. 2001;8(1):147-50.

Nutan Jain, Sweta Sareen, Swati Kanawa, Vandana Jain, Sunil Gupta, Sonika Mann. Jain point: A new safe portal for laparoscopic entry in previous surgery cases. J Hum Reprod Sci. 2016;9(1):9-17.

Hurd WW, Bude RO, De Lancey JOL, Pearl ML. The relationship of the umbilicus to the aortic bifurcation: complications for laparoscopic technique. Obstet Gynecol. 1992;80:48–51.

Jansen FW, Kapiteyn K, Trimbos-Kemper T, Hermans J, Trimbos JB. Complications of laparoscopy: a prospective multicentre observational study. Br J Obstet Gynaecol. 1997;104:595-600.

Audebert AJ, Gomel V. Role of microlaparoscopy in the diagnosis ofperitoneal and visceral adhesions and in the prevention of bowel injuryassociated with blind trocar insertion. Fertil Steril. 2000;73:631-5.

Kaali SG, Barad DH. Incidence of bowel injury due to dense adhesions of direct trocar insertions. J Reprod Med. 1992;27:617-8.

15. Agarwala N, Liu CY. Safe entry technique during laparoscopy: left upper quadrant entry using the ninth intercostal space: a review of 918 procedures. J Minim Invasive Gynecol. 2005;12:55-61.

Brill A, Nezhat F, Nezhat CH, Nezhat C. The incidence of adhesions after prior laparotomy: A laparoscopic appraisal. Obstet Gynecol. 1995;85:269-72.

Nezhat CH, Dun EC, Katz A, Wieser FA. Office visceral slide test compared with two perioperative tests for predicting periumbilical adhesions. Obstet Gynecol. 2014;123(5):104956.

Minaker S, MacPherson C, Hayashi A. Can general surgeons evaluate visceral slide with transabdominal ultrasound to predict safe sites for primary laparoscopic port placement? A prospective study of sonographically naive operators at a tertiary center. Am J Surg. 2015;209(5):804-8.

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Published

2018-06-27

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Original Research Articles