Midline incision as specimen extraction site: always to avoid? Single center experience about the use of enlarged umbilical trocar access

By the years several locations for specimen extraction site (SES) during laparoscopic surgery for colorectal disease have been proposed and many studies have focused their attention on outcomes and complications, but the 'best' SES has not yet been found. In this paper we describe our experience using the enlargement of umbilical trocar access as SES during laparoscopic colorectal surgery: at the end of the intracorporal phase we remove Hasson's trocar from the umbilicus, therefore the skin and fascial incision is enlarged up to 5-6 cm. In our work we considered 36 patients extracted from our database from 2017 with at least one year follow up. We don't report any skin closure dehiscence or surgical site infection (SSI) and in only one patient (2.7%) occurred incisional hernia (IH). The results of our study are good and an accurate wound closure at the end of the surgery and an optimal perioperative management are important to reach this goal. The enlargement of umbilical access could enable several post-operative advantages such as a fewer painful areas and a reduced number of incisions with a potential risk of SSI and incisional hernia compared to traditional SES options but further studies investigating that are needed. In the future other incisions will not be necessary except the normal trocar site ones.