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Turkish Journal of Medical Sciences

Abstract

Background/aim: Laparoscopic surgery has become the preferred minimally invasive technique for both diagnostic and therapeutic procedures in gynecology. Although it is associated with lower overall complication rates compared to open surgery, most serious complications occur during the initial step of abdominal entry. Therefore, developing faster and safer entry methods is critical to improving surgical outcomes. This study aimed to compare the surgical results of the Median Umbilical Ligament Lift-Up (MULU) technique routinely used in our clinic with the commonly preferred Veress needle (VN) entry technique.

Materials and methods: This randomized, controlled, prospective study included 124 patients: 64 underwent abdominal entry with the MULU technique and 60 with the VN technique. Demographic data such as age, BMI, obstetric and surgical history, and menopausal status were recorded. Key perioperative outcomes, including abdominal entry time, number of attempts, insufflation failure, vascular or visceral injury, bleeding at the trocar site, infection, hematoma, and hernia were documented and analyzed.

Results: The VN group had a significantly higher mean age (50.03 years) compared to the MULU group (45.42 years) (p<0.05). No significant differences were observed in height, weight, or BMI. The MULU technique demonstrated a significantly shorter mean entry time (71.5 vs. 146.3 seconds; p<0.05). Extraperitoneal insufflation occurred in 6.7% of VN cases and was absent in the MULU group (p=0.036). Gastric or intestinal injury occurred in 3.3% of VN patients, with none observed in the MULU group. Omental injury was seen only in the MULU group (3.1%). No significant differences were found in vascular injury, bleeding, or prior surgical history.

Conclusions: The MULU technique, based on anatomical guidance via the median umbilical ligament, is a safe and effective method for abdominal entry. It offers faster access and may reduce the risk of major complications, making it a viable alternative to conventional techniques.

Author ORCID Identifier

GAZİCAN GÜNERTERCAN: 0000-0003-1325-6294

AYŞE BACAKSIZ: 0000-0003-0211-2324

CAN KARABUDAK: 0009-0001-7609-0626

FİGEN EFE ÇAMİLIEFE ÇAMİLİ: 0000-0003-1790-7963

ÇİSEM ERTOK: 0000-0003-1028-9146

SİNEM ÖZŞAHİN KILIÇ: 0000-0002-9104-2788

ZELİHA SATILMIŞOĞLU: 0000-0001-5582-8102

NAZLI VURAL: 0000-0003-0493-5439

DOI

10.55730/1300-0144.6063

Keywords

Complication, laparoscopic entry, umbilicus lift technique, Veress needle

First Page

1088

Last Page

1096

Publisher

The Scientific and Technological Research Council of Türkiye (TÜBİTAK)

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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