The periumbilical area is the typical site for initial
abdominal entry during gynecologic laparoscopy.
Placing a gas insufflation needle and primary trocar
through the umbilicus, however, is deemed hazardous
in cases in which there is a risk of peritoneal and
visceral adhesions to the umbilical region. Common
alternative sites for an abdominal entry during
gynecologic laparoscopy are Palmer’s point, which is
located in the left upper quadrant 3 cm below the
costal margin in the midclavicular line, and the
Lee-Huang point, which is located at the midline
between the umbilicus and sternal xiphoid process.
Available evidence has shown both of these points
to be both feasible and safe as the initial entry site
during gynecologic laparoscopy. Other alternative
access sites include the subcostal margin in the midclavicular
line and the left ninth or tenth intercostal
space. Recently, new laparoscopic entry sites (i.e.,
Jain point and Latif’s point) have been proposed for
cases in which there is suspected adhesion due to
previous surgery. Further studies, however, are
needed to verify the safety and feasibility of these
entry techniques.
Keywords
laparoscopic entry; complications of laparoscopic entry; periumbilical adhesions; primary port