Jain point: an alternate laparoscopic non-umbilical first blind entry port to avoid vessel, viscera, adhesions and bowel (VVAB)

Abstract

The Jain point entry is based on the concept of non-umbilical entry to avoid sudden catastrophic injury to major retroperitoneal vessels, viscera, adhesions and bowel which could happen before the start of procedure by blind umbilical entry. To study the safety and efficacy of a novel first non-umbilical blind entry port. Tertiary referral centre for advanced laparoscopic surgeries with active training and fellowship programs. A large retrospective study of 7802 cases done at Vardhman Infertility & Laparoscopy Centre from January 2011 to December 2020. In all cases, first blind entry was by veress needle and 5 mm trocar and telescope through a non-umbilical port, The Jain point, irrespective of BMI, large masses, lax abdomen, previous surgery and complex situations. Patients' demographic profile, types of surgeries performed and entry-related complications were recorded and analysed. Mean age of patients was 33 years with BMI ranging from 12.66 to 54.41 kg/m². Thus, Jain point can be applicable for all ranges of BMI, all types of surgeries from simple to complex and large masses. Entry related minor complications were in 3.4% cases while major complication involving bowel occurred in one case. No case of injury to major retro-peritoneal vessel was seen. Jain point entry is a novel, first blind 5 mm non-umbilical, entry technique in a variety of surgeries and previous scars and patients with wide range of BMI. It has a short learning curve and continues as main ergonomic working port.

Keywords: Entry in previous abdominal surgeries; Jain point; Laparoscopic entry port; Left lateral port; Non-umbilical entry; Palmer’s point.

Fig. 1

Showing relative positions of all entry ports. Jain point is lowest and most lateral being 10 to 13 cm lateral to umbilicus at L 4 level. It has a single very prominent bony landmark the ASIS. Palmers point is higher and more medial hence cannot be used as a working port

Fig. 2

Optimizing the 10 mm port under the vision of 5mm port inserted at the Jain point, to avoid dense periumblical adhesions in this case

Fig. 3

Showing Jain Point port coming from adhesion free area

Fig. 4

Jain Point port continues as the main ergonomic working port in due course of the surgery

Fig. 5

BMI profile of Patients