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Teres lift-up technique: a retrospective comparative study for an alternative route for laparoscopic entry in gynecologic and oncologic surgery

  • General Gynecology
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Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

Laparoscopic surgery is the favored method for the surgical treatment of gynecologic diseases and malignancies. We have defined an anatomic landmark-based, easy-to-perform, and an alternative way of open laparoscopic entry technique named the ligamentum teres lift-up technique (TLU) that can be used in obese or normal-weight women to tackle the risks of the closed laparoscopic entry technique, namely, Veress needle entry (VNE).

Study design

In this retrospective comparative study, the participants were equally distributed to either the TLU group (n = 36) or the VNE group (n = 36) in a 1:1 ratio. The participants were stratified according to their BMI as follows: BMI between 20–25 kg/m2 (average weight), 25–30 kg/m2 (overweight), 30–35 kg/m2 (class I obesity), and 35–40 kg/m2 (class II obesity). Both laparoscopic access techniques were compared according to the entry time, vascular or visceral injuries, insufflation failures, trocar-related complications, and omental damage.

Results

The TLU group had a considerably shorter entry time than the VNE group (74.43 ± 21.45 s versus 192.73 ± 37.93 s; p < 0.001). Only one failed insufflation occurred in the VNE group (p = 0.32); however, that case was successfully insufflated with the TLU technique. Only one intestinal injury was seen in the VNE group, encountered during trocar site closure (p = 0.32). The subgroup analyses of the TLU and VNE groups based on BMI strata revealed a continuation of the statistical significance of entry time between BMI-matched groups.

Conclusion

The current study reveals that the new alternative TLU technique supplies an alternative, validated, and rapid access to the abdominal cavity in normal-weight and obese women. This new approach offers an easy-to-teach and easy-to-perform technique for surgical mentors and residents in gynecologic and oncologic surgeries.

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Data availability

The authors do not have the right to share any data information per their institution’s policies.

Code availability

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Funding

The authors declare they have no financial relationship with any company or product mentioned in this article.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Balıkesir University, Cagis Yerleskesi, Bigadic yolu 17 km, 10145, Balikesir, Turkey

    Selim Afsar, Ceyda Sancaklı Usta, Akın Usta & Duygu Lafcı

  2. Deptment of Obstetrics and Gynecology, Health Sciences University, Istanbul, Turkey

    Izel Gunay & Can Berk Karabudak

Authors
  1. Selim Afsar
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  2. Ceyda Sancaklı Usta
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  3. Akın Usta
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  4. Duygu Lafcı
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  5. Izel Gunay
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  6. Can Berk Karabudak
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Contributions

SA: conceptualization, methodology (lead), investigation, validation, visualization, writing-original draft (lead), writing-review and editing (lead), supervision (equal). CSU: investigation, supervision (equal). AU: conceptualization (lead), methodology, investigation, supervision. DL: investigation, validation. IG: validation (lead), visualization, writing-original draft. CBK: validation, visualization (lead), writing-original draft.

Corresponding author

Correspondence to Selim Afsar.

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Conflict of interest

The authors declare no conflict of interest.

Ethical approval

This retrospective comparative study was carried out as per the Helsinki Committee's principles after ethical approval of the study design by the Ethics Committee of Balikesir University (E-94025189-050.04-216887), and informed consent and consent to publish were acquired from all participants. STROBE (The Reporting of Observational Studies in Epidemiology) guidelines were followed during reporting [10].

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Afsar, S., Usta, C.S., Usta, A. et al. Teres lift-up technique: a retrospective comparative study for an alternative route for laparoscopic entry in gynecologic and oncologic surgery. Arch Gynecol Obstet 308, 1549–1554 (2023). https://doi.org/10.1007/s00404-023-07191-6

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  • DOI: https://doi.org/10.1007/s00404-023-07191-6

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