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Purpose: Although Palmer's point approach is described for upper urinary tract laparoscopy, we use this technique routinely for robotic and standard laparoscopic radical prostatectomy and we describe our experience with this approach.
Materials and Methods: Since 2004, Palmer's point Veress entry has been used to create pneumoperitoneum in 126 robotic and 21 standard laparoscopic radical prostatectomies. On the left side, a 2-mm transverse skin incision was made 3 cm below the left costal margin on the midclavicular line. Through this incision, a Veress needle was inserted to create pneumoperitoneum.
Results: The mean patients' age and body mass index were 59.7 years (range, 37 to 73 years) and 27.92 kg/m^sup 2^ (range, 22 to 39 kg/m^sup 2^), respectively. Thirty-eight patients had prior abdominal operations. The mean number of punctures performed was 1.08 per case. In 93 % of the subjects, Veress needle was inserted during the first attempt. The mean time to establish pneumoperitoneum was 5.63 minutes (range, 4 to 8 minutes). No major entrance injuries occurred.
Conclusion: Palmer's point upper quadrant Veress needle access may be a safe and effective method of establishing pneumoperitoneum in patients subjected to robotic and standard laparoscopic radical prostatectomy.
Urol J. 2010;7:152-6.
www.uj.unrc.ir
Keywords: laparoscopy, prostatectomy, prostatic neoplasms, robotics
INTRODUCTION
Laparoscopic surgery is an important part of urologic practice. Establishing pneumoperitoneum is an important step in laparoscopic surgery; however, serious complications may occur during this part of the procedure. In a recent review, establishing initial pneumoperitoneum accounted for 6% to 57% of injuries occurring during laparoscopy.(1)
Various techniques have been described to perform insufflation and place trocars. Classic closed pneumoperitoneum (Veress), open (Hasson) pneumoperitoneum, direct trocar insertion through a small incision in the peritoneum, disposable shielded trocars, radially expanding trocars, and visual entry systems are used for laparoscopic entry.(2) The most widely utilized techniques are the closed Veress technique, open Hasson technique, and direct trocar insertion without pre-existing pneumoperitoneum.(3)
To minimize entrance injuries, especially in those patients with prior abdominal operations and intraperitoneal adhesions, alternative entry sites to the closed insertion of a Veress needle at paraumbilical region have been advocated. Palmer described the use of the left subcostal pararectus region as the primary puncture site, known as Palmer's point (Figure 1). (4) This technique has mainly been...