Laparoscopic access for RARP is often initiated in the peri-umbilical location. Palmer's Point, located in the left upper quadrant, has been reported as an alternative access site for pelvic laparoscopy to reduce morbidity, but not widely reported among urologists. To better understand surgeons' preferences for access and its associated morbidity during RARP, we surveyed surgeons from two urological organizations.
An anonymous online questionnaire that assessed training, experience, and preferences for RARP was emailed in December 2014 to members of the Endourology Society (ES) and the Michigan Urological Society Improvement Collaborative (MUSIC) . Surgeons performing RARP were also asked to share their personal experience with a vascular/bowel injury or a death or life-threatening vascular event (DOLTE).
Questionnaires were answered by 111 surgeons in total (ES, n=71 and MUSIC, n=40, total response 5.5%). In total, 77% reported Veress needle experience prior to performing RARP and 71% of respondents primarily use the Veress needle for RARP access, with 73% primarily inserting at the peri-umbilical location. A personal experience with a vascular or a bowel injury during veress needle insertion was reported in 18% and 9% of surgeons, respectively; furthermore 26% of respondents were personally aware of at least 1 DOLTE among colleagues (5% reported 3 or more). The majority (56%) of respondents were unaware of Palmer's Point, while among the minority aware of Palmer's Point, only 33% reported ever using this location.
In this survey, surgeons most commonly access the abdomen at the peri-umbilical location with a Veress needle for RARP with the majority not aware or utilizing Palmer's Point. Nearly 1 in 5 surgeons reported a personal experience with a vascular injury during access for RARP. Palmer's Point, located away from major vasculature, may reduce the morbidity of access for RARP and warrants further awareness and study.
Journal of endourology. 2017 Jan 05 [Epub ahead of print]
William K Johnston Iii, Susan Linsell, David Christopher Miller, Khurshid R Ghani
Beaumont School of Medicine/Michigan Institute of Urology, Urology, Novi, Michigan, United States ; ., University of Michigan Hospital, 166144, Urology/Michigan Urological Society Improvement Collaborative) , Ann Arbor, Michigan, United States ; ., University of Michigan, Division of Urologic Oncology, Department of Urology, Ann Arbor, Michigan, United States ; ., University of Michigan, Urology, Ann Arbor, Michigan, United States ; .