Trocar Placement and Access for Laparoscopic Ventral Hernia Repair

Abstract

The laparoscopic approach to the abdominal cavity involves the use of various sizes of trocars through which instruments are introduced to perform surgical procedures for diagnostic and/or therapeutic purposes. Trocar placement and patient position are key factors in laparoscopic surgery, since the relative position determines the angle of vision and the access to the various structures, thereby affecting the ease and convenience with which the surgeon handles the procedure. Thus, the positioning of the trocars, both those used for visualization and as working channels, must be clearly described for proper laparoscopic repair of ventral hernias. There is no standard for patient and trocar positioning in laparoscopic repair of this type of hernia. Unlike other procedures, such as cholecystectomy-where the gall bladder is always in the same position-, this pathology involves several locations and sizes varying greatly in extension. Determining the optimum placement of the trocars depends on these factors and on the physical characteristics of the patient.