Laparoscopic Entry, But How?

Baris Mulayim

Department of Obstetrics and Gynaecology, Saglik Bilimleri University, Turkey

^*Correspondance to: Baris Mulayim 

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Abstract:

Background: Safe abdominal entry in laparoscopic surgery is still debated. In patients known or suspected to have periumbilical adhesions, open entry technique (Hasson method) or alternative sites other than umbilicus for insertion may be chosen, Palmer’s point is the most preferred.Method: A 27-year-old G0 P0 married women admitted to our infertility clinic for achieving pregnancy. She had infraumbilical midline laparotomy for perforated appendicitis. On physical exam, she had midline incision scar from umbilicus to symphysis, external genitalia, vagina, and cervix were unremarkable. Trans-vaginal ultrasound was unremarkable, either. Blood cell count, serum chemistry and day 3 hormonal profiles, spermiogram were within normal range. But Hysterosalpingogram revealed bilateral occlusion at tubal distal ends. For further work-up, laparoscopy was performed.Results: Due to midline incision and suspicion of periumbilical adhesions, open entry technique (Hasson method) for pneumoperitoneum was preferred. No complications were occurred. After penuemoperitoneum was achieved, laparoscopy revealed that Douglas pouch was obliterated, bilateral fimbrial ends were not seen, whole surface of the peritoneum is covered by omentumand the transvers colon was attached to the upper abdomen from side to side. The operation was ended without any intervention and considered to send the patient to the ART department. The patient was discharged at the same day.Conclusion: The safety of laparoscopic techniques depends more on skill, education, and a clear appreciation of the anatomy and physics of the abdominal wall than on the technique itself. It is important that surgeons should choose the laparoscopic entry technique they are familiar with and feel most comfortable with.

Keywords:

Laparoscopy; Entry; Palmer’s point; Hassonmethod; Adhesions

Cite the Article:

Mulayim B. Laparoscopic Entry, But How?. Ann Clin Case Rep. 2017; 2: 1262.