Transverse versus longitudinal skin incisions for totally implantable venous access port implantation: a randomized controlled trial

BACKGROUND: Totally implantable venous access ports (TIVAPs) are widely used in oncologic patients requiring long-term vascular access. However, the impact of skin incision orientation on postprocedural pain, procedural efficiency, and early complications remains unclear. This study compared transverse and longitudinal incisions in terms of early postoperative pain, patient-reported discomfort, procedure duration, and complication rates. METHODS: In this randomized, single-center study, 170 patients undergoing TIVAP implantation were assigned to either a transverse or longitudinal incision group (85 patients each). All procedures followed a standardized protocol with ultrasound-guided venous access and fluoroscopic confirmation of catheter tip position. Pain intensity was assessed using the numeric rating scale (NRS) within 24 h, and patient-reported discomfort was evaluated on day 7. Procedural characteristics and early complications were recorded. RESULTS: Postprocedural pain was low in both groups, with most patients reporting NRS scores between 0 and 2. Analgesic requirements were minimal, with no significant between-group differences. Discomfort at day 7 was also low and comparable. Procedure duration showed a trend toward shorter times in the transverse incision group [20 (18; 30) vs. 25 (20; 35) minutes; p = 0.09]. Overall complication rates were low, with no major complications. Minor complications included local inflammatory reactions and hematomas. Bleeding within the port pocket was more frequent in the longitudinal incision group, although not statistically significant. CONCLUSIONS: Transverse and longitudinal incisions provide comparable outcomes in TIVAP implantation, with low pain, minimal discomfort, and low complication rates. A trend toward shorter procedure duration and less port pocket bleeding with transverse incisions suggests potential technical advantages. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT06766656 (Registered January 04, 2025).