title: Twenty-two years of office and outpatient laparoscopy: current techniques and why I chose them.
abstract: Since 1972 I have introduced the following technical modifications in outpatient laparoscopy under local anesthesia to improve safety, economy, and patient acceptability: avoiding the insufflating needle and sharp trocar in favor of open abdominal entry, using the Hasson cannula; introducing room air for insufflation instead of nitrous oxide or carbon dioxide; using the Hulka clip in place of tubal coagulation; making a single-incision, open surgical entry through the central umbilical fossa in obese patients; and completing fascial penetration with a blunt hemostat or Kelly clamp to minimize the risk of bowel or vessel injury.
authors.affiliation: Department of Obstetrics and Gynecology, Health Science Center, State University of New York, Syracuse, New York, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Penfield
mesh_terms: D000005:Abdomen / Q000601:surgery; D000388:Air; D000556:Ambulatory Surgical Procedures / Q000191:economics / Q000295:instrumentation / Q000379:methods; D000772:Anesthesia, Local; D001808:Blood Vessels / Q000293:injuries; D002245:Carbon Dioxide; D002404:Catheterization / Q000295:instrumentation; D003365:Costs and Cost Analysis; D004564:Electrocoagulation / Q000295:instrumentation; D004867:Equipment Design; D005187:Fallopian Tubes / Q000601:surgery; D000071938:Fasciotomy; D005260:Female; D005836:Genitalia, Female / Q000601:surgery*; D006801:Humans; D007327:Insufflation / Q000295:instrumentation / Q000379:methods; D007422:Intestines / Q000293:injuries; D007431:Intraoperative Complications / Q000517:prevention & control; D020706:Laparoscopes; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D008026:Ligation / Q000295:instrumentation; D009609:Nitrous Oxide; D009765:Obesity / Q000150:complications; D017060:Patient Satisfaction; D010824:Physicians' Offices; D012449:Safety; D013246:Sterilization, Tubal / Q000191:economics / Q000295:instrumentation / Q000379:methods; D014472:Umbilicus / Q000601:surgery
chemical_list: D002245:Carbon Dioxide; D009609:Nitrous Oxide