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Abdominal access techniques used in laparoscopic surgery

Authors
Aurora Pryor, MD
Gerald Gracia, MD
Section Editor
Jeffrey Marks, MD
Deputy Editor
Wenliang Chen, MD, PhD

INTRODUCTION

Laparoscopic techniques have revolutionized the field of surgery with benefits that include decreased postoperative pain, earlier return to normal activities following surgery, and fewer postoperative complications (eg, wound infection, hernia) compared with open techniques [1]. However, unique complications are associated with gaining access to the abdomen for laparoscopic surgery. Inadvertent bowel injury or major vascular injury is uncommon, but both are potentially life-threatening complications that are most likely to occur during initial access [2-6].

The techniques for access to the peritoneal cavity, choice of access technique, placement locations, and port placement for single incision surgery will be reviewed here. Complications of laparoscopic access are discussed in separate topic reviews. (See "Complications of laparoscopic surgery".)

ABDOMINAL WALL ANATOMY

Knowledge of the anatomy of the abdominal wall is essential for the safe insertion of laparoscopic access devices. These devices traverse the skin, subcutaneous fat, variable myofascial layers, preperitoneal fat, and parietal peritoneum.

Access locations — The fascial and muscular layers of the abdominal wall are variable depending upon specific location. Anatomy at typical laparoscopic access sites and related intraabdominal anatomy are discussed below. Detailed anatomy of the abdominal wall is discussed elsewhere. (See "Anatomy of the abdominal wall".)

Midline abdomen — The midline abdominal wall is devoid of important vessels and nerves, and is a preferred initial access site for many laparoscopic procedures. (See 'Advanced access techniques' below.)

                                                  

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Literature review current through: Nov 2016. | This topic last updated: Wed Jun 17 00:00:00 GMT+00:00 2015.
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