title: Left upper quadrant approach in gynecologic laparoscopic surgery using reusable instruments.
abstract: OBJECTIVE
  To determine the usefulness of the left upper quadrant approach in gynecologic laparoscopic surgery.
  
  
  METHODS
  Retrospective study (Canadian Task Force classification II-2).
  
  
  METHODS
  University referral center.
  
  
  METHODS
  Twenty-four women with longitudinal scars from previous laparotomy through or close to the umbilicus.
  
  
  METHODS
  Left upper quadrant was chosen as the site of primary entry of the reusable Veress needle (ninth or tenth left intercostal space) and reusable primary cannula (left upper quadrant just below the left subcostal margin).
  
  
  RESULTS
  Intraabdominal adhesions between old longitudinal scars and underlying bowel or omentum were present in 14 patients. Adhesions involving omentum only were present in 10 patients, bowel only in 2, and both omentum and bowel in 2. The only intraoperative complication was emphysema in one woman. All operative procedures were completed laparoscopically.
  
  
  CONCLUSIONS
  The left upper quadrant approach is a safe entry point for reusable instruments at laparoscopic surgery in patients with midline incisions close to the umbilicus.
authors.affiliation: Department of Obstetrics and Gynaecology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong.
authors.forename: K W
authors.initials: KW
authors.lastname: Lam
authors.forename: T C
authors.initials: TC
authors.lastname: Pun
mesh_terms: D004646:Emphysema / Q000209:etiology; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000379:methods*; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000517:prevention & control