Novel Method for Open-Access Laparoscopic Port Insertion Using the Killian Nasal Speculum: The Lister Technique

Abstract

Safe insertion of the first port during laparoscopic surgery has always been problematic, from the early use of the Veress needle to the open Hasson technique. We describe a novel, safe, and well-illuminated technique of port entry using the Killian nasal speculum. This technique has been used successfully in transperitoneal laparoscopic nephrectomy as well as extraperitoneal radical prostatectomy in our department. The Killian nasal speculum has an built-in light source allowing excellent vision, and its narrow "beak" perfectly separates the fat and rectus sheath, and allows muscle splitting without the need for any other instrument or assistant. This technique has been employed in obese patients, allowing easy access, and it creates a tight, leakproof entry port. The Killian nasal speculum is available in all hospitals that offer an ear, nose, and throat service, and comes in four different sizes and lengths to suit all types of patients.

Techniques – Speculum-assisted approach for efficient open laparoscopic port access in the morbidly obese

“…The only other report of an assisting speculum device was by Adshead and colleagues in 2007. They published a method of using a Killian nasal speculum for all of their initial port entries describing quick entry with a single surgeon and useful in obese populations (5). In our experience, the pediatric vaginal speculum provides more visualization of the fascia layers due to its wider blades and better retraction of subcutaneous fat in the obese population.…”

Re: Flap retraction during septoplasty

“…2. Alternative solutions include using a smaller speculum like Thudichum’s or an illuminated Killian’s speculum 2–4 Slow hydrodissection using diluted adrenaline alone or in combination with local anaesthetic agents can provide better access to the sub‐perichondrial layer and provide adequate haemostasis 5 .…”

“…2. Alternative solutions include using a smaller speculum like Thudichum’s or an illuminated Killian’s speculum 2–4 …”