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E-Z Point: A New Safe and Reproducible Laparoscopic Entry in the Left Upper Quadrant Using a Veress Needle
Ghadear Shukr1, Madeleine R Gonte1,2,3, Victoria E Webber1,2
1Department of Minimally Invasive Gynecologic Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
Background:
Over half of all fatal complications occur during primary laparoscopic entry. In our practice, we developed a novel modification of closed LUQ entry at Palmer's point and designated it "E-Z" entry.
Aims:
To evaluate the risks and safety of left subcostal entry, a technique we have designated 'E-Z' entry at our institution.
Settings And Design:
A retrospective chart review was conducted at a tertiary care medical centre of patients who underwent laparoscopic procedures by a single surgeon known to perform left subcostal entry for the last 10 years, using the E-Z entry technique.
Materials And Methods:
Retrospective chart review and description of surgical technique.
Statistical Analysis Used:
Simple descriptive statistics and univariate two-group comparisons.
Results:
One hundred ninety-eight laparoscopic cases were identified as performed by a single surgeon in the last 10 years: 149 underwent umbilical entry and 49 underwent E-Z entry. The average number of previous abdominal surgeries was higher in the E-Z entry group compared to the umbilical group, 1.3 versus 0.5, respectively (P = 0.003). The umbilical entry group had no complications. One complication was noted with the E-Z entry technique, in which the Veress needle was noted to perforate the liver capsule but was managed expectantly.
Conclusion:
We propose the E-Z entry technique for Veress needle entry as an ergonomic and easily reproducible entry technique in the left upper quadrant in the setting of suspected intraperitoneal adhesions.
