Abstract
Objectives: This study aimed to describe a modified, curved, deep, bidirectional, intra-umbilical, vertical incision for primary trocar insertion and prospectively compare its intraoperative and postoperative outcomes with an infra-umbilical incision in gynaecologic laparoscopy. Methods: Between August 2019 and March 2021, 110 patients subjected to the direct trocar insertion technique for laparoscopic intervention were classified into two groups. Group A comprised 55 cases of infra-umbilical incision, whereas group B comprised 55 cases of a modified, curved, longitudinal, deep, bidirectional, intra-umbilical incision. Afterwards, intraoperative and postoperative assessments were performed. Results: The increase in the numbers of parity, gravidity and previous caesarean sections was found to be statistically significant; a smaller number of infertility complaints were observed in group B. Similarly, group B expressed a statistically significant less peri-trocar CO2 leakage (46 [83.6%] patients versus 28 [50.9%] patients) and more tightness of the primary portal entry (45 [81.8%] patients versus 30 [54.5%] patients) when compared to group A throughout the whole operation. After a one-month follow-up, a statistically significant (P = 0.029) decrease in the Observer Scar Assessment Scale and Patient Scar Assessment Scale scores in group B (10.4 ± 4.2 and 11.8 ± 4.3, respectively), demonstrating better cosmoses when compared to group A (13.3 ± 5.7 and 16.0 ± 6.8, respectively). Conclusion: Performing a modified, curved, deep, bidirectional, intra-umbilical, vertical incision for the insertion of a primary laparoscopic trocar (i.e. Darwish laparoscopic entry) is a simple and fast step that results in the elimination of intraoperative gas leakage and trocar slippage without the need for any additional sutures. Aesthetically, it results in a better scar with satisfactory cosmoses when compared to an infra-umbilical incision.
Publication details
- DOI
- 10.18295/squmj.5.2023.027
- Journal
- Sultan Qaboos University Medical Journal, 23(4), 455-462
- Publisher
- Sultan Qaboos University
- Open access
- Gold open access
- License
- CC BY-ND 4.0
Cite this article
APA 7
Darwish, A., Tawfik, M., Gaflan, A., & Darwish, D. (2025). Intraoperative and Postoperative Outcomes of Modified Bidirectional Intra-Umbilical Incision versus Infra-Umbilical Incision for Direct Trocar Insertion in Gynaecological Laparoscopy: A randomised controlled trial. Sultan Qaboos University Medical Journal, 23(4), 455-462. https://doi.org/10.18295/squmj.5.2023.027
MLA 9
Darwish, Atef, et al. "Intraoperative and Postoperative Outcomes of Modified Bidirectional Intra-Umbilical Incision versus Infra-Umbilical Incision for Direct Trocar Insertion in Gynaecological Laparoscopy: A randomised controlled trial." Sultan Qaboos University Medical Journal, vol. 23, no. 4, 2025, pp. 455-462. https://doi.org/10.18295/squmj.5.2023.027.
Chicago (author–date)
Darwish, Atef, Mohammad Tawfik, Amal Gaflan, and Dina Darwish. 2025. "Intraoperative and Postoperative Outcomes of Modified Bidirectional Intra-Umbilical Incision versus Infra-Umbilical Incision for Direct Trocar Insertion in Gynaecological Laparoscopy: A randomised controlled trial." Sultan Qaboos University Medical Journal 23 (4): 455-462. https://doi.org/10.18295/squmj.5.2023.027.
Harvard
Darwish, A., Tawfik, M., Gaflan, A. and Darwish, D. (2025) 'Intraoperative and Postoperative Outcomes of Modified Bidirectional Intra-Umbilical Incision versus Infra-Umbilical Incision for Direct Trocar Insertion in Gynaecological Laparoscopy: A randomised controlled trial', Sultan Qaboos University Medical Journal, 23(4), pp. 455-462. doi:10.18295/squmj.5.2023.027.
Vancouver
Darwish A, Tawfik M, Gaflan A, Darwish D. Intraoperative and Postoperative Outcomes of Modified Bidirectional Intra-Umbilical Incision versus Infra-Umbilical Incision for Direct Trocar Insertion in Gynaecological Laparoscopy: A randomised controlled trial. Sultan Qaboos University Medical Journal. 2025;23(4):455-462. doi:10.18295/squmj.5.2023.027
IEEE
A. Darwish, M. Tawfik, A. Gaflan, and D. Darwish, "Intraoperative and Postoperative Outcomes of Modified Bidirectional Intra-Umbilical Incision versus Infra-Umbilical Incision for Direct Trocar Insertion in Gynaecological Laparoscopy: A randomised controlled trial," Sultan Qaboos University Medical Journal, vol. 23, no. 4, pp. 455-462, 2025, doi: 10.18295/squmj.5.2023.027.