A randomized controlled prospective study comparing surgical outcomes of median umbilical ligament lift-up and Veress needle entry techniques in gynecologic laparoscopic surgery

Abstract

Background/aim: Laparoscopic surgery has become the preferred minimally invasive technique for both diagnostic and therapeutic procedures in gynecology. Although it is associated with lower overall complication rates compared to open surgery, most serious complications occur during the initial step of abdominal entry. Therefore, developing faster and safer entry methods is critical to improving surgical outcomes. This study aimed to compare the surgical results of the median umbilical ligament lift-up (MULU) technique routinely used in our clinic with the commonly preferred Veress needle (VN) entry technique. Materials and methods: This randomized, controlled, prospective study included 124 patients: 64 underwent abdominal entry with the MULU technique and 60 with the VN technique. Demographic data such as age, body mass index (BMI), obstetric, surgical history, and menopausal status were recorded. Key perioperative outcomes, including abdominal entry time, number of attempts, insufflation failure, vascular or visceral injury, bleeding at the trocar site, infection, hematoma, and hernia were documented and analyzed. Results: The VN group had a significantly higher mean age (50.03 years) compared to the MULU group (45.42 years) (p < 0.05). No significant differences were observed in height, weight, or BMI. The MULU technique had a significantly shorter mean entry time compared to VN (71.5 vs. 146.3 s, respectively, p < 0.001). Extraperitoneal insufflation occurred in 6.7% of VN cases and was absent in the MULU group (p = 0.036). Gastric or intestinal injury occurred in 3.3% of VN patients, with none observed in the MULU group. Omental injury was only seen in the MULU group (3.1%). No significant differences were found in vascular injury, bleeding, or prior surgical history. Conclusions: The MULU technique, based on anatomical guidance via the median umbilical ligament, is a safe and effective method for abdominal entry. It offers faster access and may reduce the risk of major complications, making it a viable alternative to conventional techniques.