Access site : Umbilical vs suprapubic (laparoscopy)
|Discussion in 'All Categories' started by Dr Chua Peng Teng MBBS MOG FMAS DMAS - Nov 15th, 2017 8:47 am.
Dr Chua Peng Teng MBBS MOG FMAS DMAS
|Dear Sirs Dr Mishra and Dr Chowhan
Prior to attending training in WLH I have favoured supraumbilical access. After completion of training I have returned and started using incision on the inferior margin of umbilicus as primary veress entry and pneumoperitoneum access.
For a few cases I have difficulty where in my veress after 2 clicks and started on insufflator, pressure is high and I have to revert to supraumbilical access which insufflated successfully. Upon entry I have seen that my first attempt created subcutaneous emphysema.My difficulty was experienced in both slim and obese patients. I used the technique of lifting abd wall up for slim patients and create a 45 and 90 deg angle as taught for normal pt. For obese pt i enter veress near perpendicular to skin.
Request sir provide opinion and guide as to what went wrong and trouble shoot options
re: Access site : Umbilical vs suprapubic (laparoscopy) by Dr J S Chowhan - Jan 5th, 2018 2:41 pm
Dr J S Chowhan
|Dear Dr Chua Peng Teng
If you are using inferior crease of umbilicus before introducing trocar please dilate the vitellointestinal track by mosquito forcep. Subcutaneous emphysema is due to tearing of peritoneum or high pressure of pneumoperitoneum. For obese patient going perpendicular is always correct. If you will do irrigation, suction and hanging drop test it will give you the idea that your veress needle is inside peritoneum or not. If you can record the steps of access video and upload through the member area we can help you to correct the steps.
Dr J S Chowhan