Despite numerous recent technical advances in minimally invasive surgical technique, the potential exists for serious morbidity during initial laparoscopic access. Safe access depends on adhering to well-recognized principles of trocar insertion, knowledge of abdominal anatomy, and recognition of hazards imposed by previous surgery. Applying these principles, we describe a safe, rapid, and cost-effective technique for laparoscopic access using readily available instruments. This technique emphasizes identification and incision of the point at which the midline abdominal fascia is fused with the base of the umbilicus, and the importance of the application of countertraction directly at the point of insertion. This method allows penetration under direct vision with minimal controlled axial force, and without the requirement for fascial sutures or other cumbersome aspects of the traditional open technique. While previous reports describe techniques for laparoscopic access entry based on similar anatomic and surgical principles, we describe an alternative method not yet discussed in the surgical literature.
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The authors acknowledge Kirsty Sanders, R.N., C.N.O.R., for her assistance in filming and editing video footage demonstrating this access technique.
The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government. This manuscript does not involve any grant support.
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Antevil, J.L., Bhoyrul, S., Brunson, M.E. et al. Safe and Rapid Laparoscopic Access—a New Approach. World J. Surg. 29, 800–803 (2005). https://doi.org/10.1007/s00268-005-7730-3
- Veress Needle
- Trocar Insertion
- Laparoscopic Access
- Intraabdominal Injury
- Umbilical Cicatrix