EXTRAUMBILICAL INSERTION OF THE OPERATIVE LAPAROSCOPE IN PATIENTS WITH EXTENSIVE INTRAABDOMINAL ADHESIONS

In 72 patient 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 preven t direct intestinal injury. After inserting the laparoscope through th is point, four women were found to have extreme intestinal adhesions a round the umbilical area, and intestinal or severe omental injury migh t occur if the cannulas were inserted directly through the umbilical f ossa. The other eight patients had omentum, partial to severe, adheren t to the anterior abdominal wall. No complication occurred during inse rtion of the Veress needle and primary cannula through Palmer's point. Nine patients had successful laparoscopic adhesiolysis and were disch arged within 2 days. In the other three women the procedure was con ve rted to laparotomy because of extensive intestinal adhesions (2 patien ts) and small bowel injury during laparoscopic adhesiolysis (1). Palme r's point can be considered a safe and good alternative site for inser ting the Veress needle and primary cannula to lyse dense intestinal an d extensive omental adhesions. This technique should provide the surge on with wider visual angle and surgical field, thus making adhesiolysi s much easier to perform.