Demonstration of Safe Entry Techniques for Laparoscopy

Study Objective: To demonstrate different techniques, and detail the considerations for obtaining primary laparoscopic access in gynecologic surgery. Design: Video demonstration of the techniques with narrated discussion of each method. Setting: The methods for primary entry in laparoscopy vary by location and technique [1,2]. There are inherent risks with any mode of primary entry, and the risks are also specific to each technique [3–6]. The choice for primary entry depends on the patient's anatomy, surgical history, pathology, and surgeon preference [1,2]. Interventions: This video reviews considerations for choosing the safest entry point and tips for proper entry technique [4,7–10]. The entry sites reviewed include the umbilicus, left upper quadrant, right upper quadrant, and supraumbilical [11]. The entry technique can be either open (Hasson), closed (Veress), or by direct laparoscopic visualization [9,10,12–14]. Conclusion: No single laparoscopic entry technique is superior [3]. The safest and most successful entry method will vary by case characteristics and surgeon training.