Direct optical entry through Palmer’s point: a new technique for those at risk of entry-related trauma at laparoscopy

Abstract

We present a technique of direct optical entry through Palmer's point (3 cm below the left costal margin in the mid-clavicular line) as an alternative laparoscopic entry method for those gynaecological patients at risk of periumbilical adhesions. This method has been used in 15 patients and allowed the adhesions to be cleared where necessary. We feel that this technique can provide a safe approach to the abdominal cavity and should be considered as another method alongside closed and open umbilical techniques in the laparoscopic gynaecologist's repertoire.

An unusual case of pneumomastia: mammographic appearances

“…In this particular case, the presence of anterior abdominal wall adhesions between omentum and peritoneum had necessitated a Palmer's point entry (ie, a laparoscopic porthole 3 cm below the left costal margin in the midclavicular line). This allows the surgeon safe access to the pelvis 5. It seems reasonable to assume that the proximity of the porthole to the left breast explains why, in this case, air tracked to the left breast and not the right.…”

Laparoscopic entry after previous surgery

“…Successful use of a closed entry technique at Palmer's point using a 5 mm optical trocar for primary entry has recently been reported . This potentially reduces the risk of inadvertent injuries from the Veress needle and is certainly worth considering as an alternative to the traditional technique described above.…”

Hasson's cut-down technique through Palmer's point

“…The authors have described a new technique which uses a direct optical entry method at Palmer's point (3 cm below the left costal margin in the midclavicular line) [2]. By doing this, one is allowed a visual inspection of the umbilicus and ensuing adhesiolysis to allow subsequent insertion of an umbilical port under direct vision.…”