[Significance of umbilical position for the operative approach in minimally invasive hysterectomy]

Abstract

Umbilicus is a main reference point for insufflation of CO2 in the peritoneal cavity.

Aim: Proposing of individualization of trocar placement, based on the type of surgery and the anthropometric parameters of patient.

Material and methods: Several distances on the anterior abdominal wall were measured in 61 patients of the Oncogynecology Clinic - Pleven with a view to determination of the location of umbilicus.

Results and discussion: Umbilicus is a median structure in horizontal and vertical line in patients of underweight, normal weight, and overweight, and could be used as a main reference point for allocation of ports for robotic and laparoscopic radical hysterectomy. The distance between xiphoid process and umbilicus, and the waist circumference are increased in obese patients, which facilitates the trocar placement for robotic surgery. However the access for laparoscopic hysterectomy is more difficult in obese patients, due to allocation of ports in the lower portion of anterior abdominal wall, where more fat is accumulated.

Conclusion: Providing of "convenient" access is a crucial step for performing of elective endoscopic surgical intervention.