We perform an umbilical zigzag incision technique as we published in our papers. It is hidden in the bottom of umbilicus.

Hi Takehiro Hachisuka.Could you explain more about your zigzag incision,its lenght and position?thanks.

Thank you for your question, Dr. Gehnaz Gohari. Our zigzag incision is 2.5cm in length and extended to 5cm. So, we can get 5cm opening of fascia by wound retractor. By making the incision at the beginning of lap surgery and attach GelPOINT, we can perform lap colectomy with 2 additional ports as the same manner. It automatically becomes reduced port surgery. At the end of the operation, the incision is repaired by plastic surgeon's technique, resulting in almost scarless. Please refer to my paper in Asian Journal of Endoscopic Surgery published in 2012.

Article Transumbilical laparoscopic surgery using GelPort through an...

A photo of a patient who underwent laparoscopic sigmoidectomy by an umbilical zigzag skin incision technique 1 year ago. Can you see the scar? Almost invisible!

Thank you so much Dr.Takehiro Hachisuka for your answer.It is so usefull method.The picture is wonderfull too.

This technique depends on plastic surgeon's experiences of umbilicodeformities. I also originated this method from my experiences of laparoscopic living donor nephrectomy, in which the incision for organ extraction is made at the beginning to shorten the warm ischemia for the donor kidney. My zigzag technique is the combination.

Thank you Dr Hachisuka. I use frequently the Gelpoint via an abdominal incision with a plasty close than yours. But the esthethic result seems better with your technic, so i will try it

Dear Dr. Frederic Dumont,

Thank you for your comment on our technique.

As you say, the preceeding umbilical incision by plastic surgeon's technique is very useful to RPS, resulting in scarless surgery.

I eagerly wait for your results by our technique here.

TH

In my opinion, there isn't the best place for specimen extraction , but this depend of localization of trocars, type of patient ( sex, age, body) and size of specimen.

In the young woman we prefer a mini sovrapubic incision. In case of left colon laparoscopic resection we enlarge the incision of left 10 mm trocars .

Thank you for your answer, Dr. Lombardi.

Your opinion is traditional and feasible.

However, if we try to hide scar more, umbilicus is one of the best place in a human body. It is a kind of natural orfice. In case of HAR for Sigmoid colon cancer, our preceeding inciosion techique with umbilical zigzag incision is very easy to do, resulting in RPS. TH

Are there somebody who tried zigzag incision?

I hear some Japanese surgeons make presentations about Zigzag technique in the World Congress held in Paris just now. Please check.

In our opinion the best way possible to perform specimen removal is by vaginal extraction as described in Culdolaparoscopy (Operative Culdolaparoscopy: a novel approach combining operative culdoscopy and minilaparoscopy .J. Am Assoc.Gyn Laparoscop . 2001;8:438-441) and in Minilaparoscopy Assisted Natural Orifice Surgery (JSLS. 2007 Jan-Mar; 11(1): 24–29.)

Thank you, Dr. Tsin. I agree your answer in ceses of women. However, in men, umbilicus is best, I think.

We presented other options:

Minilaparoscopy as an alternative to natural orifice surgery

www.slideshare.net/.../minilaparoscopy-as-an-alternative-to-natural-orific...

May 4, 2011 - Minilaparoscopy as an Alternative to Natural Orifice Surgery Daniel Tsin, MD Dawar Mahmood, MD Panagiotis Manolas , MD Joan Padouvas, ...

We presented : Minilaparoscopy as an alternative to natural orifice surgery.

available in slideshare.net

using a suprapubic port instead of the vaginal port.

Periumbilcal or suprapubic curve incision as the site of specimen extraction.

I use umbilical for small and supra pubic for bigger specimens.