Laparoscopically Assisted 4-Point Transversus Abdominis Plane Block with Cadaveric Dissection

Abstract

Video Objective To demonstrate the technique for a four-point transversus abdominis plane (TAP) block under laparoscopic visualization for robotic assisted gynecologic procedures. Images from our cadaveric dissection aid the viewer in learning the specific anatomy for the technique. In this educational video we outline each step of the four-point TAP block which surgeons may implement into their clinical practice in efforts to minimize post-operative opiate use. Setting Academic community hospital setting and institutional cadaver lab. Interventions We perform a laparoscopically assisted four-point TAP block on all robotic-assisted gynecologic procedures unless there is a contraindication. Blocks are placed by the surgeon after insertion of the laparoscope. For the subcostal injection the lower costal margin is palpated, and the injection site is identified two centimeters inferior and medial to the mid-axillary line. For the inferior injection the anterior superior iliac spine is palpated and the injection is two centimeters superior and medial to the mid-axillary line. Introduction of a regional anesthesia needle is simultaneously observed externally and laparoscopically. This method along with detailed anatomical landmarks, through our cadaveric dissection, are presented sequentially in our video. Conclusion A four-point TAP block is a safe, efficacious, yet simple procedure which can be performed by the surgeon under laparoscopic visualization.