Placement of umbilical trocar - Forum

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Dottore

Placement of umbilical trocar - Ärzteforum

Post#1 »

Female,28, with cholelithiasis has a small periumbilical hernia. I would like to do lap chol. Any advice regarding the placement of umbilical trocar. Pt also likes the hernia repaired at the same sitting.


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Old surgeon

Re: Placement of umbilical trocar - Ärzteforum

Post#2 »

Use Hassan technique and, with the Hassan cannula for your camera port and put it through the hernia defect. When you are done, close the hernia/trochar site.

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Resident

Re: Placement of umbilical trocar - Ärzteforum

Post#3 »

I have repaired an umbilical hernia at the same setting as a lap chole. First, an incision was made over the hernia sac. When the fascial edges were well defined, sutures were placed and the Hasson trochar was introduced through the hernia. It was very difficult to obtain a tight enough seal to contain the pneumoperitoneum, so the hernia was partially repaired (Mayo style...vest over pants) and then it was much easier. Still, it continually leaked through the procedure and if I had it do to over again (and I'm sure I will) I would have reduced but not repaired the hernia, then placed the Hasson trochar superior to it (to avoid any adhesions), performed the lap chole, and repaired the hernia at the end.

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surgery

Re: Placement of umbilical trocar - Ärzteforum

Post#4 »

I would insert the umbilical port via open technique and go ahead with the lap cholecystectomy, and repair the hernia on completion of the procedure.

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Treatment guru

Re: Placement of umbilical trocar - Ärzteforum

Post#5 »

I would make the incision straight through a small umbilical hernia.

I use these tricks with varying success to stop air leaks around the Hasson trocar:
1. Usual sutures on each side put in as half pursestrings after opening the fascia
2. In obese patients especially, get the entire Hasson olive beneath the skin otherwise, the Hasson olive tends to pull outward, so there is not a snug fit of the Hasson olive at the fascial level
3. Use towel clips as needed (sometimes several) to approximate the skin around the Hasson

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