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J Turk Ger Gynecol Assoc. 2017 Sep 1;18(3):143-147. doi: 10.4274/jtgga.2017.0046.

Exploring the umbilical and vaginal port during minimally invasive surgery.

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Department of Gynecology and Obstetrics, Division of Experimental Endoscopic Surgery, Imaging, Minimally Invasive Therapy and Technology, Vito Fazzi Hospital, Lecce, Italy
Laboratory of Human Physiology, Department of Applied Mathematics, Moscow Institute of Physics and Technology (MIPT), State University, Moscow, Russia
The Mount Sinai Hospital of Queens, Long Island City, New York, USA
Advanced International Mini-Invasive Surgery Academy, Milan, Italy
Center for Innovative Surgery (ZIC), Center for Bariatric and Metabolic Surgery, Department of General, Visceral and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité-Universitätsmedizin, Berlin, Germany
Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium
Department of Obstetrics and Gynecology, Santa Maria Hospital, GVM Care&Research, Bari, Italy
Consultant, German Board-Surgery; Chairman, Department of Surgery; Chief, General Surgery Danat Al Emarat Hospital, UAE
Clinic of Gynecology and Obstetrics, Clinical Center of Serbia, University of Belgrade School of Medicine, Belgrade, Serbia
Department of Obstetrics, Gynecology and Reproductive Medicine, State University of New York at Stony Brook School of Medicine, Stony Brook, NY; Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, NY, USA
Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA


This article focuses on the anatomy, literature, and our own experiences in an effort to assist in the decision-making process of choosing between an umbilical or vaginal port. Umbilical access is more familiar to general surgeons; it is thicker than the transvaginal entry, and has more nerve endings and sensory innervations. This combination increases tissue damage and pain in the umbilical port site. The vaginal route requires prophylactic antibiotics, a Foley catheter, and a period of postoperative sexual abstinence. Removal of large specimens is a challenge in traditional laparoscopy. Recently, there has been increased interest in going beyond traditional laparoscopy by using the navel in single-incision and port-reduction techniques. The benefits for removal of surgical specimens by colpotomy are not new. There is increasing interest in techniques that use vaginotomy in multifunctional ways, as described under the names of culdolaparoscopy, minilaparoscopy-assisted natural orifice surgery, and natural orifice transluminal endoscopic surgery. Both the navel and the transvaginal accesses are safe and convenient to use in the hands of experienced laparoscopic surgeons. The umbilical site has been successfully used in laparoscopy as an entry and extraction port. Vaginal entry and extraction is associated with a lower risk of incisional hernias, less postoperative pain, and excellent cosmetic results.


Single port laparoscopy; colpotomy postoperative pain.; culdolaparoscopy; natural endoscopic surgery

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