Optimization of access-port placement for the XXXX -band system.

@entity1 @entity28286 @entity3813
BACKGROUND: The technical aspects of access-port (AP) placement are not generally described in @entity3813 -Band series. METHODS: From November 2000 to April 2002, we performed @entity3813 -Band procedures laparoscopically on 180 @entity1 . A retrospective review was conducted of 3 consecutive AP-placement techniques in nonselected and demographically identical groups. In Group A (n=48, Nov. 2000 to July 2001), the AP was placed at the left subcostal margin. In Group B (n=23, Aug. 2001 to Sept. 2001), the AP was tunneled over the subcostal fascia towards the subxiphoid area. In Group C (n=109, Oct. 2001 to Apr. 2002), the AP tubing was tunneled over the subcostal fascia and connected to the AP, which was inserted through a 3-cm subxiphoid incision. RESULTS: AP-related problems occurred within the first few months following surgery. In Group A, 24 of the @entity28286 (50%) were tilted, and 14 (29%) were completely flipped over. 11 @entity28286 (23%) were found to be broken. 19 @entity1 (40%) underwent an additional AP-related procedure. In group B, 12 @entity28286 (52%) were tilted and 1 @entity1 required surgery to turn the AP. In Group C, 8 @entity28286 (7%) were turned slightly. 1 AP was found to be broken and required surgery to replace it. In this group, all @entity28286 were accessible for adjustment in the office. CONCLUSIONS: Tunneling the AP along the left subcostal area is an important technique to protect the AP system from breakage, by changing AP-tube position from vertical to horizontal in relation to abdominal wall movement. This technique also keeps the AP-tube connection over the fascia and protects it from "wear and tear" forces. The addition of fixation at the subxiphoid location helps maintain a straight orientation of the AP for easier adjustments.
