Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Overview of gynecologic laparoscopic surgery and non-umbilical entry sites

Howard T Sharp, MD
Section Editor
Tommaso Falcone, MD, FRCSC, FACOG
Deputy Editor
Kristen Eckler, MD, FACOG


In gynecology, laparoscopic surgery is used for many procedures that were traditionally performed via laparotomy. These are performed for benign and malignant disease [1]. Conventional (also referred to as “straight stick”) and robotic approaches are used.

General issues related to gynecologic laparoscopic procedures will be reviewed here. Laparoscopic access, instrumentation, and complications, as well as robot-assisted laparoscopy, are discussed separately. (See "Abdominal access techniques used in laparoscopic surgery" and "Instruments and devices used in laparoscopic surgery" and "Complications of laparoscopic surgery" and "Robot-assisted laparoscopy".)

Specific uses of laparoscopy are discussed in individual topic reviews:

(See "Laparoscopic surgery for ovulation induction in polycystic ovary syndrome".)

(See "Laparoscopic hysterectomy".)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Mar 30, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Schlaerth AC, Abu-Rustum NR. Role of minimally invasive surgery in gynecologic cancers. Oncologist 2006; 11:895.
  2. Chapron C, Fauconnier A, Goffinet F, et al. Laparoscopic surgery is not inherently dangerous for patients presenting with benign gynaecologic pathology. Results of a meta-analysis. Hum Reprod 2002; 17:1334.
  3. Nieboer TE, Johnson N, Lethaby A, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2009; :CD003677.
  4. Medeiros LR, Stein AT, Fachel J, et al. Laparoscopy versus laparotomy for benign ovarian tumor: a systematic review and meta-analysis. Int J Gynecol Cancer 2008; 18:387.
  5. Shveiky D, Aseff JN, Iglesia CB. Brachial plexus injury after laparoscopic and robotic surgery. J Minim Invasive Gynecol 2010; 17:414.
  6. Agostini J, Goasguen N, Mosnier H. Patient positioning in laparoscopic surgery: tricks and tips. J Visc Surg 2010; 147:e227.
  7. Irvin W, Andersen W, Taylor P, Rice L. Minimizing the risk of neurologic injury in gynecologic surgery. Obstet Gynecol 2004; 103:374.
  8. Berquer R, Smith WD, Davis S. An ergonomic study of the optimum operating table height for laparoscopic surgery. Surg Endosc 2002; 16:416.
  9. van Det MJ, Meijerink WJ, Hoff C, et al. Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines. Surg Endosc 2009; 23:1279.
  10. Klauschie J, Wechter ME, Jacob K, et al. Use of anti-skid material and patient-positioning to prevent patient shifting during robotic-assisted gynecologic procedures. J Minim Invasive Gynecol 2010; 17:504.
  11. Varma R, Gupta JK. Laparoscopic entry techniques: clinical guideline, national survey, and medicolegal ramifications. Surg Endosc 2008; 22:2686.
  12. Cuss A, Bhatt M, Abbott J. Coming to terms with the fact that the evidence for laparoscopic entry is as good as it gets. J Minim Invasive Gynecol 2015; 22:332.
  13. Ahmad G, Gent D, Henderson D, et al. Laparoscopic entry techniques. Cochrane Database Syst Rev 2015; 8:CD006583.
  14. Whiteside JL, Barber MD, Walters MD, Falcone T. Anatomy of ilioinguinal and iliohypogastric nerves in relation to trocar placement and low transverse incisions. Am J Obstet Gynecol 2003; 189:1574.
  15. Tsin DA, Colombero LT, Mahmood D, et al. Operative culdolaparoscopy: a new approach combining operative culdoscopy and minilaparoscopy. J Am Assoc Gynecol Laparosc 2001; 8:438.
  16. Howard RE Jr. Laparoscopy. Preliminary experience. Va Med Mon (1918) 1972; 99:1063.
  17. Neely MR, McWilliams R, Makhlouf HA. Laparoscopy: routine pneumoperitoneum via the posterior fornix. Obstet Gynecol 1975; 45:459.
  18. Mintz M. Risks and prophylaxis in laparoscopy: a survey of 100,000 cases. J Reprod Med 1977; 18:269.
  19. van Lith DA, van Schie KJ, Beekhuizen W, du Plessis M. Cul-de-sac insufflation: an easy alternative route for safely inducing pneumoperitoneum. Int J Gynaecol Obstet 1980; 17:375.
  20. Wolfe WM, Pasic R. Transuterine insertion of Veress needle in laparoscopy. Obstet Gynecol 1990; 75:456.
  21. Santala M, Järvelä I, Kauppila A. Transfundal insertion of a Veress needle in laparoscopy of obese subjects: a practical alternative. Hum Reprod 1999; 14:2277.
  22. Sanders RR, Filshie GM. Transfundal induction of pneumoperitoneum prior to laparoscopy. J Obstet Gynaecol Br Commonw 1974; 81:829.
  23. Trivedi AN, MacLean NE. Transuterine insertion of Verres needle for gynaecological laparoscopy at Southland Hospital. N Z Med J 1994; 107:316.
  24. Morgan HR. Laparoscopy: induction of pneumoperitoneum via transfundal puncture. Obstet Gynecol 1979; 54:260.
  25. Agarwala N, Liu CY. Safe entry techniques during laparoscopy: left upper quadrant entry using the ninth intercostal space--a review of 918 procedures. J Minim Invasive Gynecol 2005; 12:55.
  26. Audebert AJ, Gomel V. Role of microlaparoscopy in the diagnosis of peritoneal and visceral adhesions and in the prevention of bowel injury associated with blind trocar insertion. Fertil Steril 2000; 73:631.
  27. Sepilian V, Ku L, Wong H, et al. Prevalence of infraumbilical adhesions in women with previous laparoscopy. JSLS 2007; 11:41.
  28. Jansen FW, Kapiteyn K, Trimbos-Kemper T, et al. Complications of laparoscopy: a prospective multicentre observational study. Br J Obstet Gynaecol 1997; 104:595.
  29. Childers JM, Brzechffa PR, Surwit EA. Laparoscopy using the left upper quadrant as the primary trocar site. Gynecol Oncol 1993; 50:221.
  30. Granata M, Tsimpanakos I, Moeity F, Magos A. Are we underutilizing Palmer's point entry in gynecologic laparoscopy? Fertil Steril 2010; 94:2716.
  31. Parker J, Rahimpanah F. The advantages of microlaparoscopic left upper quadrant entry in selected patients. Aust N Z J Obstet Gynaecol 2001; 41:314.
  32. Pasic R, Levine RL, Wolf WM Jr. Laparoscopy in morbidly obese patients. J Am Assoc Gynecol Laparosc 1999; 6:307.
  33. Pelosi MA 3rd, Pelosi MA. Alignment of the umbilical axis: an effective maneuver for laparoscopic entry in the obese patient. Obstet Gynecol 1998; 92:869.
  34. Schwartz ML, Drew RL, Andersen JN. Induction of pneumoperitoneum in morbidly obese patients. Obes Surg 2003; 13:601.
  35. Hurd WW, Bude RO, DeLancey JO, Pearl ML. The relationship of the umbilicus to the aortic bifurcation: implications for laparoscopic technique. Obstet Gynecol 1992; 80:48.
  36. Hurd WH, Bude RO, DeLancey JO, et al. Abdominal wall characterization with magnetic resonance imaging and computed tomography. The effect of obesity on the laparoscopic approach. J Reprod Med 1991; 36:473.
  37. Nezhat F, Brill AI, Nezhat CH, et al. Laparoscopic appraisal of the anatomic relationship of the umbilicus to the aortic bifurcation. J Am Assoc Gynecol Laparosc 1998; 5:135.
  38. Härkki-Sirén P, Kurki T. A nationwide analysis of laparoscopic complications. Obstet Gynecol 1997; 89:108.
  39. Neudecker J, Sauerland S, Neugebauer E, et al. The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery. Surg Endosc 2002; 16:1121.
  40. Magrina JF. Complications of laparoscopic surgery. Clin Obstet Gynecol 2002; 45:469.