Page 16 - Textbook of Practical Laparoscopic Surgery by Dr. R. K. Mishra

CHAPTER 6: Abdominal Access Techniques 15

Fig. 37: Skin incision for open technique. Fig. 38: Hemostat is stabbed into the peritoneum.

A B
Figs. 39A and B: Finger insertion after open access will confirm adhesion.

Fig. 40: Introduction of Hasson trocar. Fig. 41: Fixation of Hasson trocar.

■ ■Small tiny adhesion felt can be broken with gentle ■ ■Attach the gas (typically CO ) to the port and insufflate
2
sweeping movement of finger. the abdomen. Fast insufflation should be avoided to
■ ■Blunt trocar-cannula should be inserted for the first prevent vasovagal shock.
port after visualizing the intraperitoneal viscera
(Fig. 40). Advantages of Open Technique
■ ■Care is taken not to make a big incision; cannula dilates ■ ■Definite, small risk of injury with blind Veress needle
the smaller incision to give an airtight fit. technique irrespective of experience.
■ ■If incision is big, rectus string should be tightened to ■ ■Particularly useful in previous abdominal surgery or
hold the port in proper position (Fig. 41). underlying adhesions.