Access to the Abdomen
Initial access to the abdomen may be achieved percutaneously with a Veress needle (closed technique), or by a small cutdown and direct placement of a blunt-tipped Hassan cannula into the peritoneum under visual control (open technique). A variety of optical access trocars are also available, but most are used after pneumoperitoneum is first established percutaneously. Laparoscopic surgeons need to be facile in both the open and closed techniques, but most have a strong preference for one or the other method and will use that method preferentially, modifying the technique if unusual circumstances exist. This chapter uses the case of a healthy young woman with no previous abdominal surgery to explore these choices and preferences. Both techniques are thoroughly described in the SAGES manuals.
KeywordsRectus Sheath Bowel Injury Closed Technique Previous Abdominal Surgery Veress Needle
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