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Related Experiment Videos

Left upper quadrant approach in gynecologic laparoscopic surgery using reusable instruments.

K W Lam1, T C Pun

  • 1Department of Obstetrics and Gynaecology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong.

The Journal of the American Association of Gynecologic Laparoscopists
|April 18, 2002
PubMed
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The left upper quadrant approach is a safe entry point for laparoscopic surgery in women with prior midline incisions. This method minimizes risks associated with adhesions, ensuring successful gynecologic procedures.

Area of Science:

  • Minimally Invasive Gynecologic Surgery
  • Surgical Access Techniques

Background:

  • Previous laparotomies, especially midline incisions, can lead to intraabdominal adhesions.
  • Adhesions pose a risk of injury to bowel and omentum during subsequent laparoscopic surgery.
  • Standard entry points may be compromised by adhesions near previous surgical scars.

Purpose of the Study:

  • To evaluate the utility of the left upper quadrant (LUQ) approach for primary trocar insertion in gynecologic laparoscopy.
  • To assess the safety and efficacy of the LUQ approach in patients with umbilical or periumbilical longitudinal scars.

Main Methods:

  • Retrospective study of 24 women undergoing gynecologic laparoscopic surgery.
  • Primary entry was established using a Veress needle and cannula in the LUQ.

Related Experiment Videos

  • Patients had longitudinal scars from previous laparotomies near the umbilicus.

    • Main Results:

    • Intraabdominal adhesions were identified in 14 patients, involving omentum and/or bowel.
    • The LUQ approach facilitated successful laparoscopic completion of all procedures.
    • One case of emphysema was the sole intraoperative complication.

    Conclusions:

    • The left upper quadrant approach is a safe and effective alternative entry site for laparoscopic surgery.
    • This technique is particularly useful in patients with midline incisions close to the umbilicus, where adhesions are common.