BACKGROUND
Performing laparoscopy in patients who have had previous abdominal surgery is often made more hazardous due to the presence of intra-abdominal adhesions. The umbilical port can usually be inserted safely under direct vision using an open technique; however, adhesions commonly form between bowel and the anterior abdominal wall, preventing visualisation of the anterior abdominal wall in order to insert secondary ports.
TECHNIQUE
A needle mounted on a syringe to use as a handle is inserted through the anterior abdominal wall under direct vision of the laparoscope. This needle is then advanced through the adhesions and the side of the bevelled tip of the needle used to incise the adhesions (Fig. 1). This can be repeated, inserting the needle in different places, until sufficient adhesiolysis has been performed to allow visualisation of the abdominal cavity distally and safe insertion of a secondary port under direct vision of the laparoscope. Once another port is safely in place, an instrument can be passed to divide any remaining adhesions.
Figure 1.
Using a needle to incise intra-abdominal adhesions. Arrow head points to the tip of a needle passed through the abdominal wall.
CONCLUSION
We have found this to be a simple technique which makes laparoscopic port insertion in the presence of adhesions safer.