Left upper quadrant approach in gynecologic laparoscopic surgery with reusable instruments

Study Objective. To determine the usefulness of the left upper quadrant approach in gynecologic laparoscopic surgery. Design. Retrospective study (Canadian Task Force classification II-2). Setting. University referral center. Patients. Twenty-four women with longitudinal scars from previous laparotomy through or close to the umbilicus. Intervention. Left upper quadrant was chosen as the site of primary entry of the reusable Veress needle (ninth or tenth left intercostal space) and reusable primary cannula (left upper quadrant just below the left subcostal margin). Measurements and Main Results. Intraabdominal adhesions between old longitudinal scars and underlying bowel or omentum were present in 74 patients. Adhesions involving omentum only were present in 10 patients, bowel only in 2, and both omentum and bowel in 2. The only intraoperative complication was emphysema in one woman. All operative procedures were completed laparoscopically. Conclusion. The left upper quadrant approach is a safe entry point for reusable instruments at laparoscopic surgery in patients with midline incisions close to the umbilicus.