Microlaparoscopy using an optical Veress needle inserted at Palmer's point

Abstract

Objective To avoid vascular and visceral injury in a patient undergoing laparoscopic adhesiolysis and known to have extensive intra‐abdominal adhesions. Design An optical Veress needle was used to establish pneumoperitoneum under direct vision through Palmer's point. Safe sites were identified for the insertion of the secondary trocars. Result Satisfactory laparoscopic adhesiolysis was performed without any complications. Conclusion Microlaparoscopy using an optical Veress needle inserted through Palmer's point seems to be a safe technique for avoiding laparoscopic injury when extensive adhesions are suspected.

Optical Veress as an entry technique

“…As at other centres, we have modified this technique somewhat by using the Optical Veress at Palmer's point in our high risk patients. 20,[26][27][28] The small calibre of these instruments, combined with surprisingly good image quality, has led to the development of micro/minilaparoscopy with conscious patients, particularly in the US managed patient care system. [29][30][31] This is a controversial area in laparoscopic surgery at the moment, and we await evidence of its superiority over conventional laparoscopy under general anaesthesia (with all its attendant risks) before attempting this approach.…”

Microendoscopy in gynaecology: a critical review

“…The main advantage in their use is the ability to confirm the location of the primary trocar early in the procedure. We have also used these instruments to enter the abdomen via Palmer’s point 25 in those of our patients who were at high risk for laparoscopic perforation, 26 allowing a potentially safer entry while leaving a scar which is cosmetically more acceptable.…”