The reliability of using jain point and supraumbilical entry point, laparoscopic entry points, in patients with predicted adhesions or failed median entry

Laparoscopy is a common procedure in various surgical specialties. Complications arising from laparoscopy are typically associated with the initial entry into the abdominal cavity. Any previous abdominal surgery, history of pelvic infection, endometrioma, or significant adhesion formation due to chemotherapy/ radiotherapy can be relevant preoperative factors that should be investigated to guide the laparoscopic surgeon in preventing injuries. The purpose of this study is to prove that the laparoscopic Jain point and supraumbilical entry point are suitable and feasible for performing laparoscopy in patients with a history of abdominal surgery and a large adnexal mass (greater than 10 cm), minimizing potential problems during the initial entry. The study included all patients aged 18 and above who underwent gynecological operations through laparoscopic Jain and supraumbilical entry points at the Suleyman Demirel University Faculty of Medicine Hospital Women's Health and Obstetrics Clinic between January 2021 and June 2023. The study is a retrospective descriptive study. A total of 72 patients were identified through a screening of the hospital information system. Out of these, 15 patients underwent operations through the laparoscopic Jain point, and 57 patients underwent operations through the supraumbilical entry point. The data were transferred to IBM SPSS 23 (IBM Inc., Chicago, IL, USA) for statistical analysis. 15 (20.8%) of the patients included in the study were operated on through the Jain point, while 57 (79.2%) were through the Supraumbilical point. Of the patients, 42 (58.3%) had adhesions in the abdominal wall, 11 (15.3%) at the umbilicus, and 26 (36.1%) on the abdominal sidewall. Supraumbilical entry was preferred for patients with pelvic masses greater than 10 cm. For patients with a significant midline incision, such as ileus, entry through the Jain point was preferred. Additionally, in 5 (33.3%) patients with central obesity, entry through the Jain point was preferred, and no complications were detected. For patients who had undergone umbilical hernia repair with mesh, entry through the Jain or Supraumbilical points was chosen based on the surgical indication According to the results, complications occurred intraoperatively in 3 (4.2%) of the performed operations. Of the patients, 42 (58.3%) had adhesions in the abdominal wall, 11 (15.3%) at the umbilicus, and 26 (36.1%) on the abdominal sidewall. This result indicates that using the commonly employed umbilical entry point may increase our complication rate. The use of this alternative entry point has ensured our protection against complications. Another result of our study is that the character of previous surgeries, rather than their quantity, increases the severity and rate of adhesions. While 66.6% of Jain point patients had median and umbilical incisions, only 7.1% of Supraumbilical point patients had umbilical incisions. Ovarian cyst was the indication in 26.7% of Jain point patients and 5.4% of Supraumbilical point patients. In 28.1% of Supraumbilical point patients, the indication was a pelvic mass greater than 10 cm, while this indication was not observed in Jain point patients. This highlights the importance of supraumbilical entry for performing laparoscopic surgery in patients with a large pelvic mass. Particularly in patients with a midline incision and central obesity, the Jain point should be preferred. Additionally, for patients with umbilical hernia repair, the alternative entry point should be determined based on the patient's surgical indication. Our study results indicate that the choice between Jain and supraumbilical entry points, based on the patient's history and indication, provides a safe alternative entry point for the surgeon Keywords: Jain, Supraumbilical, Median, Pelvic mass, , Laparoscopy