賴明坤

天主教靈醫會羅東聖母醫院 泌尿科

Ming-Kuen Lai

Division of Urology, Camillians Saint Mary’s Hospital Luodong

 

Purpose: For general awareness of safe abdominal entry in laparoscopic surgery, related literatures were reviewed and summarized for educational purpose.

Materials and Methods: Using “laparoscopic surgery”, “abdominal entry” as key words, literature searching was performed on Ovid and PubMed. Pertinent literatures were quoted.

Results: Laparoscopic entry can be performed with an open (ie, Hasson), or closed (eg, Veress needle, visual entry trocar e.g., Visiport) technique. Complications are associated with gaining access to the peritoneal cavity for laparoscopic surgery. Bowel injury or major vascular injury is uncommon, but it is potentially life-threatening and is most likely to occur during initial access. The midline abdominal wall is devoid of important vessels and nerves, and is a preferred initial access site for many laparoscopic procedures. Decompression of the stomach with a nasogastric tube and bladder decompression with a Foley catheter can maximize the view of the upper abdominal and pelvic operating fields and minimize risk for injury. Previous midline abdominal incision can be associated with significant underlying adhesions. Alternative access sites should be chosen. Transumbilical access is the most common location for access with a pneumoperitoneum (eg, Veress) needle. Access at the costal margin can be useful for a variety of upper abdominal laparoscopic procedures. Palmer’s point can also be used as a site for initial insufflation of the abdomen with a Veress needle when a transumbilical site cannot be used or is not preferred.

Conclusion: Knowledge of the anatomy of the abdominal wall is essential for the safe insertion of laparoscopic access devices.