Subkostaler Einstich in der Medioklavikularlinie zur primären Insufflation und Inspektion im Rahmen der gynäkologischen Laparoskopie

Abstract

Laparoscopy using subcostal insertion is particularly mentioned in the literature in connection with cholecystectomies and nephrectomies. Subcostal access was chosen for placement of the Veress needle and the primary trocar in 72 patients. The following indications have been considered: prior midline vertical abdominal incisions, previous described periumbilical adhesions, prior peritonitis, umbilical hernias, obesity. The location of the incision was subcostal of the 9th rib in the midclavicular line. 28 patients (43.1%) had periumbilical, 23 (32.0%) had subumbilical omental adhesions. Periumbilical bowl adhesions have been described for 12 patients (16.7%) and 20 (27.8) had subumbilical bowl adhesions. One patient required laparotomy. There have been no complications during the operation or postoperative in the remaining 71 patients. The subcostal insertion is a safe location for primary trocar placement and can possibly help to prevent serious omental or bowl lesions.