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Related Experiment Videos

Laparoscopy using the left upper quadrant as the primary trocar site

J M Childers1, P R Brzechffa, E A Surwit

  • 1University of Arizona, Department of Obstetrics and Gynecology, Tucson 85712.

Gynecologic Oncology
|August 1, 1993
PubMed
Summary
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Laparoscopic surgery in high-risk patients is safe when using the left upper quadrant for primary trocar placement. This approach minimizes risks associated with subumbilical adhesions, ensuring patient safety.

Area of Science:

  • Minimally Invasive Surgery
  • Surgical Safety
  • Abdominal Surgery

Background:

  • Subumbilical adhesions pose a significant risk during laparoscopic procedures.
  • Previous midline incisions or umbilical hernias increase the likelihood of these adhesions.
  • Safe primary trocar placement is crucial in patients with high adhesion risk.

Purpose of the Study:

  • To evaluate the safety and efficacy of left upper quadrant primary trocar placement.
  • To assess the incidence of subumbilical adhesions in high-risk patients.
  • To establish guidelines for safe laparoscopic entry in challenging cases.

Main Methods:

  • Laparoscopic surgery was performed on 41 high-risk patients.
  • Insufflation utilized a Veress needle in the left upper quadrant (9th intercostal space).

Related Experiment Videos

  • Primary trocar insertion was performed in the left upper quadrant, adjacent to the subcostal margin.

    • Main Results:

    • Sixty-eight percent (28/41) of patients presented with subumbilical adhesions.
    • One enterotomy occurred with an 11-mm trocar, necessitating laparotomy.
    • No complications were observed in the remaining 40 patients using smaller primary trocars.

    Conclusions:

    • Left upper quadrant primary trocar placement is a safe strategy for patients at high risk for subumbilical adhesions.
    • Adherence to specific guidelines, including trocar size, is essential for safety.
    • This technique offers a viable alternative to traditional entry methods in complex cases.