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Left upper quadrant approach in gynecologic laparoscopic surgery.

Siew-Fei Ngu¹, Vincent Y T Cheung, Ting-Chung Pun

¹Department of Obstetrics and Gynecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR. ngusiewf@hku.hk

Acta Obstetricia Et Gynecologica Scandinavica

|August 23, 2011

Summary

The left upper quadrant approach is a safe and effective method for accessing the abdominal cavity in gynecologic laparoscopic surgery. It is particularly useful for patients with a history of abdominal surgery or large pelvic masses.

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Area of Science:

Gynecologic Surgery
Minimally Invasive Procedures
Surgical Techniques

Background:

Laparoscopic surgery is a common approach for benign gynecologic conditions.
Access to the peritoneal cavity can be challenging in patients with prior abdominal surgery or large pelvic masses.
The left upper quadrant (LUQ) approach offers an alternative entry point for laparoscopic procedures.

Purpose of the Study:

To evaluate the efficacy and safety of the LUQ approach in benign gynecologic laparoscopic surgery.
To identify indications and outcomes associated with the LUQ approach over a nine-year period.

Main Methods:

Retrospective review of medical records from January 2002 to December 2010.
Inclusion criteria: women undergoing laparoscopic gynecologic surgery using the LUQ approach.

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Data collected: demographics, surgical history, indications, intraoperative findings, diagnoses, and complications.

Main Results:

143 patients (4.9% of all gynecologic laparoscopic surgeries) utilized the LUQ approach.
Primary indications: previous open abdominal surgery (79.0%), pregnancy (11.1%), large pelvic mass (6.2%).
Adhesions were present in 58.4% of patients with prior abdominal surgery; 8.3% required conversion to laparotomy.

Conclusions:

The LUQ approach is an effective, safe, and accessible technique for peritoneal entry in gynecologic laparoscopy.
Consideration of the LUQ approach is recommended for patients with risk factors for periumbilical adhesions or large pelvic masses.