This study aims to evaluate the clinical effectiveness, anatomical benefits, and postoperative outcomes of the STIRRUP incision (Suprapubic Transverse Incision with Rectus Release for Upper Peritoneal Access) by comparing outcomes with historically established benchmarks and published data from traditional abdominal wall incisions used in complex gynecologic surgery.
Female patients aged 18-65 years
Indication for open gynecologic surgery for benign or borderline pelvic or abdominopelvic masses
Body Mass Index (BMI) ≥ 18 kg/m²
Willing and able to provide informed consent and attend follow-up
Malignant tumors requiring upper abdominal visceral resection (liver, spleen, diaphragm)
Emergency surgery
Previous complex abdominal wall reconstruction with mesh
Contraindication to general anesthesia
Single group
STIRRUP (Suprapubic Transverse Incision with Rectus Release for Upper Peritoneal access) technique
Procedure/SurgerySkin incision: A low curvilinear transverse incision will be made 2-3 cm above the pubic symphysis, corresponding to the Pfannenstiel site. Subcutaneous dissection: The subcutaneous tissue will be elevated between Scarpa's fascia and the anterior rectus sheath for approximately 10-12 cm cephalad. Anterior rectus sheath incision: A transverse incision will be made in the anterior rectus sheath approximately 10-12 cm above the pubis, parallel to the skin incision. The linea alba will not be divided, thereby preserving midline fascial integrity. Rectus muscle separation: Beneath the fascial window, the rectus muscles will be separated bluntly at the midline, as in the Pfannenstiel approach, to expose the posterior sheath and peritoneum. No transection of muscle fibers will be performed. Peritoneal entry: The peritoneum will be opened sharply under direct vision.
Postoperative seroma formation
clinically detectable subcutaneous fluid collection at the incision site, confirmed clinically and/or by ultrasound when indicated.
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