Laparoscopy Using the Left Upper Quadrant as the Primary Trocar Site

Childers, Joel M.; Brzechffa, Peter R.; Surwit, Earl A.

doi:10.1006/gyno.1993.1196

Cited by 83 publications

(34 citation statements)

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“…Palmer's point entry using initial Veress needle insufflation has been reported by a number of authors in the form of case series [7][8][9]. In a randomised study, Azevedo and colleagues [10] compared intraumbilical and left hypochondrium Veress entry.…”

Section: Discussionmentioning

confidence: 99%

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

2009

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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.

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Section: Discussionmentioning

confidence: 99%

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

2009

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“…Injury to the great vessels caused by the needle is the most common cause of death during laparoscopy 7 . The most common entry points of the Veress needle are the umbilical region -considered the standard entry point 6 -the left subcostal margin [8][9][10] , an intermediate point between the upper edge of the pubic symphysis and the umbilicus 16 and a point identical to McBurney's, in the left iliac fossa 6 . There are also reports of gaining access to the peritoneal cavity through transfixion of the fundus of uterus with a needle introduced into the cervical canal of uterus 17 , and transfixion of the thoracoabdominal wall through the left ninth intercostal space 10 .…”

Section: Discussionmentioning

confidence: 99%

“…Even incisions made away from the umbilicus may lead to adhesion formation in the periumbilical region 3 . On the other hand, insertion of the Veress needle into the left hypochondrium has been reported as safe, with reduced risk of iatrogenic injury [8][9][10] . The stomach is immediately below the anterior abdominal wall at the site where the left hypochondrium puncture is made.…”

Section: Methodsmentioning

confidence: 99%

“…All injuries to the great vessels caused by the Veress needle reported in the literature resulted from midline punctures in the umbilical region 2,3,5 . The risk of iatrogenic injury is minimized when the needle is not inserted through the midline [8][9][10] . Patients with previous abdominal surgery are more prone to visceral injury caused by the Veress needle 3 .…”

Section: Methodsmentioning

confidence: 99%

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Veress needle insertion in the left hypochondrium in creation of the pneumoperitoneum

Azevedo

Sorbello³

et al. 2006

Acta Cir. Bras.

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PURPOSE: To test the efficacy of the puncture in the left hypochondrium as an alternative method. METHODS: Sixty-two patients randomly distributed into two groups were studied: Group LH, puncture in the left hypochondrium (n=30), and Group ML, puncture in the abdominal midline (n=32). The following were assessed: needle positioning tests, number of failed attempts at needle insertion, and time needed for creation of pneumoperitoneum. Gas flow, volume and intraperitoneal pressure were recorded at every 20 seconds, until a 12 mmHg pressure was reached inside the peritoneal cavity. RESULTS: A similar number of positive results for the needle positioning tests were observed in both groups. Two failed attempts to reach the peritoneal cavity were observed in Group ML and one in Group LH. The time necessary for the creation of pneumoperitoneum was on average 3 minutes and 46 seconds for Group LH, and 4 minutes and 2 seconds for Group ML. Average gas flow, volume and pressure were equivalent for both groups. CONCLUSION: Puncture in the left hypochondrium was as effective as puncture in the abdominal midline for the creation of pneumoperitoneum.

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“…One of the alternative sites is the left mid-clavicular subcostal space, however, splenomegaly and a distended stomach determined by palpation precludes insertion at this site [3,4]. Another alternative site is transfundal placement of the Veress needle [5,6].…”

Section: Creation Of Pneumoperitoneummentioning

confidence: 99%