SURGICAL TECHNIQUES AND INNOVATIONS
Skin Incision for Port Placement in Laparoscopic
Surgery—an Often Forgotten Critical Step!
Received: 25 April 2017 /Accepted: 6 September 2017 / Published online: 13 September 2017
Association of Surgeons of India 2017
Abstract Port placement is the first and one of the most
important step in laparoscopic surgeries. However, these
incisions for port placement are often placed casually
leading to larger or smaller incisions than those re-
quired. Larger incisions may lead to problems like ooz-
ing from skin incisions, egress of gas used to create
pneuomoperitoneum, while smaller incisions lead to dif-
ficulty in port introduction and incision site skin necro-
sis. We describe a simple and novel technique of giving
proper sized skin incision to avoid such problems.
Keywords Laparoscopic port
Point of Technique
Port placement is the first step in laparoscopic surgeries, and
incisions given for them are often the only ones visible to the
patient. However, these incisions made for insertion of ports
are mostly placed by a rough estimate often leading to too
long or short incisions. These problems are more frequently
encountered during the early years of laparoscopic training.
An inadequately sized incision can lead to intraoperative
and postoperative problems, sometimes the only ones in an
otherwise uneventful surgery. An incision larger than the port
size can potentially lead to gas leaking from around the port.
Also, the benefit of stopping oozing from the skin margins by
the tamponading effect of a snuggly fitted port is lost, with
resultant continuous oozing/trickling of blood during at least
the initial part of surgery.
An incision smaller than the required size would lead
to obvious difficulties in port placement. Even after place-
ment, a larger port in a relatively smaller incision exerts
continuous pressures on the skin margins leading to tissue
necrosis and increased risk of surgical site infections.
Also, when the incision is enlarged in such a scenario to
facilitate port placement, the resultant final incision is
often larger than the optimum one.
McKay and Blake have previously described a method
to find out the optimum length of incision for port inser-
tion, wherein they calculated the skin incision in
millimetres using the mathematical equation for circum-
ference of a circle (i.e. π × diameter) and dividing the
resultant value by half, taking the length of incision as
equivalent to half the circumference of the port (e.g.
19 mm incision for a 12 mm port) (Fig. 1). As circle
is a continuous figure and not merely a sum of two linear
lines, this calculation tends to overestimate the skin inci-
sion. It is worthy to note that the shortest distance to reach
a destination is a straight line drawn to that point, remem-
bering physics. The practice of using a scale to measure
the skin incision routinely is not often followed and easily
forgotten during laparoscopic surgeries. Also, the end of
all ports is not perfectly circular with some being oval, as
showninFig.2, wherein this formula for a circle would
not be appropriately applicable.
Department of Surgical Disciplines, AIIMS, Room number 5025,
Teaching Block, New Delhi, India
Indian J Surg (December 2017) 79(6):574–575