title: Extraumbilical insertion of the operative laparoscope in patients with extensive intraabdominal adhesions.
abstract: In 12 patients who had known or suspected intraabdominal adhesions, we evaluated the benefit of using Palmer's point for inserting the Veress needle and primary cannula during laparoscopic adhesiolysis to prevent direct intestinal injury. After inserting the laparoscope through this point, four women were found to have extreme intestinal adhesions around the umbilical area, and intestinal or severe omental injury might occur if the cannulas were inserted directly through the umbilical fossa. The other eight patients had omentum, partial to severe, adherent to the anterior abdominal wall. No complication occurred during insertion of the Veress needle and primary cannula through Palmer's point. Nine patients had successful laparoscopic adhesiolysis and were discharged within 2 days. In the other three women the procedure was converted to laparotomy because of extensive intestinal adhesions (2 patients) and small bowel injury during laparoscopic adhesiolysis (1). Palmer's point can be considered a safe and good alternative site for inserting the Veress needle and primary cannula to lyse dense intestinal and extensive omental adhesions. This technique should provide the surgeon with wider visual angel and surgical field, thus making adhesiolysis much easier to perform.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, 5 Fu-Hsing Street, Kwei-Shan, Tyo-Yuan, Taiwan 10591, Republic of China.
authors.forename: F H
authors.initials: FH
authors.lastname: Chang
authors.forename: H H
authors.initials: HH
authors.lastname: Chou
authors.forename: C L
authors.initials: CL
authors.lastname: Lee
authors.forename: P J
authors.initials: PJ
authors.lastname: Cheng
authors.forename: C W
authors.initials: CW
authors.lastname: Wang
authors.forename: Y K
authors.initials: YK
authors.lastname: Soong
mesh_terms: D000005:Abdomen / Q000601:surgery*; D015746:Abdominal Pain / Q000601:surgery; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000601:surgery; D007415:Intestinal Obstruction / Q000601:surgery; D007421:Intestine, Small / Q000293:injuries; D007422:Intestines / Q000293:injuries; D007431:Intraoperative Complications; D020706:Laparoscopes; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007813:Laparotomy; D009339:Needles / Q000009:adverse effects; D009852:Omentum / Q000293:injuries / Q000601:surgery; D010351:Patient Discharge; D010532:Peritoneal Diseases / Q000601:surgery; D000267:Tissue Adhesions / Q000601:surgery; D014472:Umbilicus / Q000601:surgery