A small incision will be made by extending the periumbilical port for the camera scope in both groups. The size of the small incision will be determined based on the size of the tumour and the physical habits of the patient. The fascial closure methods are standardised as continuous closure using Stratafix (SF Symmetric PDS Plus®) with a 4:1 ratio (4-to-1 suture to wound length ratio) and bites of < 1 cm. The methods for closure of the subcutaneous fat and skin (skin stapler or 3–0 nylon vertical mattress) depend on the surgeon’s discretion. Patients randomly assigned to the midline group will undergo an incision along the midline skin, subcutaneous fat, and linea alba.
In the non-muscle-cutting periumbilical transverse group, the method of small incision is the same as in a previous report (Fig.2 ) [6 (link)]. Briefly, the skin incision of the 11-mm periumbilical port will be extended transversely. Using monopolar electrocautery and crossing linea alba, the anterior and posterior rectus sheaths are transversely incised. With lateral traction of the rectus abdominis muscle with an army retractor, the posterior rectus sheath can be seen (Supplemental Video 1). The transversalis fascia and parietal peritoneum are further incised transversely. Continuous fascia closure will be separately performed for the anterior and posterior rectus sheaths. Implementing vertical or transverse incisions will not require alteration to usual care pathways (including the use of any medication), and these will continue for both trial arms.![]()
In the non-muscle-cutting periumbilical transverse group, the method of small incision is the same as in a previous report (Fig.
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