Baseball Diamond Concept of Port Position in Minimal Access Surgery by Dr R K Mishra


Laparoscopic techniques have revolutionized the field of surgery with benefits that include decreased postoperative pain, earlier return to normal activities following surgery, and fewer postoperative complications like wound infection, and hernia. However, unique complications are associated with gaining access to the abdomen for laparoscopic surgery. Inadvertent bowel injury or major vascular injury is uncommon, but both are potentially life-threatening complications that are most likely to occur during initial access. The techniques for access to the peritoneum, choice of access, multiple port placement, and complications of access will be reviewed here. Laparoscopic issues and complications not related to abdominal access are discussed in separate topic reviews.

Port Position in Minimal Access Surgery

Correct port position is the most important ergonomics required to perform successful laparoscopic surgery. Following points has to be keps in Mind while performing laparoscopic surgery to achoive a correct port position.

1. Laparoscopic Instrument should behave like Type I Lever

2. Telescope should be in the middle of Working Instrument

3. Manipulation angle should be 60 degree

4. Elevation angle should be Ideally 30 degree

5. Distance between telescope and instrument should not be less than 5 cm

6. Distance between two working instrument should not be more than 15 Cm

7. Azimuth angle should be minimum 15 degree and maximum 45 degree Ideally it should be 30 degree either side

8. Shadow of the telescope should be below the object so light cable should be up

We investigated the optimal position of the instrument and laparoscope in relationship to the working ports. The optical angle, defined as the angle formed by the line of action determined by the working ports and the line of vision determined by the laparoscope, was varied by 30 degrees intervals from 15 degree degrees to the left and 45 degree to to the right that is called Azimuth angle. We also studied the time taken to accomplish a standardized task of tying a square knot with each optical angle in a laparoscopic simulator setting. The optimal position is at the optical angle of 0 degree. The optimal range of the optical angle is 60 degrees to the left and 60 degrees to the right of the optimal position.

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