title: Left upper quadrant approach in gynecologic laparoscopic surgery.
abstract: OBJECTIVE
  To review the use of the left upper quadrant approach in benign gynecologic laparoscopic surgery over a nine-year period.
  
  
  METHODS
  Retrospective review. Setting. University-affiliated hospital.
  
  
  METHODS
  Women who underwent laparoscopic gynecologic surgery the upper quadrant approach between January 2002 and December 2010.
  
  
  METHODS
  Medical records were reviewed.
  
  
  METHODS
  Demographic data, past surgical histories, indications for surgery and the use of the left upper quadrant approach, intraoperative findings, diagnosis and any complications.
  
  
  RESULTS
  143 patients were identified, accounting for 4.9% of all gynecologic laparoscopic surgery. The indications for using the left upper quadrant approach were: previous open abdominal surgery (113, 79.0%), surgery in the second trimester of pregnancy (16, 11.1%), presence of large pelvic mass (9, 6.2%), previous transverse rectus abdominis myocutaneous flap for breast reconstruction (3, 2.0%), previous periumbilical hernia repair (1, 0.6%) and previous laparoscopic umbilical wound dehiscence (1, 0.6%). In women with previous abdominal surgery, the overall incidence of adhesions between omentum and/or bowel to the anterior abdominal wall in the umbilical region was 58.4%. Twelve (8.3%) patients required conversion to laparotomy. One patient had subcutaneous surgical emphysema over the left upper quadrant entry site.
  
  
  CONCLUSIONS
  The left upper quadrant approach is an effective, safe and easy technique for peritoneal cavity access in women undergoing laparoscopic gynecologic surgery and should be considered in women with risk factors of periumbilical adhesions and in the presence of a large pelvic mass.
authors.affiliation: Department of Obstetrics and Gynecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR. ngusiewf@hku.hk
authors.forename: Siew-Fei
authors.initials: SF
authors.lastname: Ngu
authors.forename: Vincent Y T
authors.initials: VY
authors.lastname: Cheung
authors.forename: Ting-Chung
authors.initials: TC
authors.lastname: Pun
mesh_terms: D000328:Adult; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D010529:Peritoneal Cavity / Q000601:surgery; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000517:prevention & control