SUBCOSTAL INSERTION IN THE MIDCLAVICULAR LINE FOR PRIMARY INSUFFLATION AND INSPECTION IN GYNECOLOGICAL LAPAROSCOPIC SURGERY

Laparoscopy using subcostal insertion is particularly mentioned in the literature in connection with cholecystectomies and nephrectomies. Su bcostal access was chosen for placement of the Veress needle and the p rimary trocar in 72 patients. The following indications have been cons idered: prior midline vertical abdominal incisions, previous described periumbilical adhesions, prior peritonitis, umbilical hernias, obesit y. The location of the incision was subcostal of the 9th rib in the mi dclavicular line. 28 patients (43.1%) had periumbilical, 23 (32.0%) ha d subumbilical omental adhesions. Periumbilical bowl adhesions have be en described for 12 patients (16.7%) and 20 (27.8) had subumbilical bo wl adhesions. One patient required laparotomy. There have been no comp lications during the operation or postoperative in the remaining 71 pa tients. The subcostal insertion is a safe location for primary trocar placement and can possibly help to prevent serious omental or bowl les ions.