Open Access

MINIMALLY INVASIVE AND ROBOTIC SURGERY

Optimal port placement during laparoscopic radical prostatectomy

Ashis Chawla, Adnan Qureshi, Aziz Alamri, Edward D. Matsumoto

Department of Surgery, Division of Urology, McMaster University, Hamilton, Ontario, Canada
Address correspondence to Dr. Edward Matsumoto, Department of Urology, St. Joseph’s Hospital, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6 Canada

Canadian Journal of Urology 2012, 19(1), 6142-6146.

Abstract

Introduction: Placement of anterior abdominal wall trocars during laparoscopic radical prostatectomy (LRP) carries the risk of inadvertent injury to the inferior epigastric artery (IEA) and potential conflict between midline and lateral ports. We described and evaluated a new measured port placement approach.
Materials and methods: The intervention group included patients who underwent LRP using a specifically measured five-port approach. The medial 10 mm ports were placed 5 cm from the patient’s midline at a level midway between the anterior superior iliac spine (ASIS) and the umbilicus. The control group had five ports placed at the surgeon’s discretion. We prospectively compared intraoperative blood loss, need for port repositioning, and incidence of adverse surgical events.
Results: In the intervention cohort (n = 112), the course of the IEA was found to be lateral to the medial 10 mm port in all cases. There were no adverse surgical outcomes in this group. In the control group (n = 97), three patients experienced IEA injuries (p < 0.01), and three required port repositioning (p < 0.01). The mean blood loss between groups was not significantly different (p = 0.70).
Conclusion: Our specifically measured port placement approach reliably allows for positioning the trocar medial to the IEA. This minimizes the risk of IEA injury, facilitates adequate instrument manipulation, and reduces the need for port repositioning.

---

Keywords

---