SRINAGARIND MEDICAL JOURNAL

Volume 36, No. 02, Month MARCH, Year 2021, Pages 240 - 245

Alternative access sites for abdominal entry in gynecologic laparoscopy a literature review and narrative summary of findings

Nuntasiri Eamudomkarn, Sanguanchoke Luanratanakorn, Kanok Seejorn

Abstract Download PDF

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

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