Novel method for open-access laparoscopic port insertion using the killian nasal speculum: the lister technique.

PURPOSE: Safe insertion of the first port during laparoscopic surgery has always been problematic, from the early use of the Veress needle to the open Hasson technique. We describe a novel, safe, and well-illuminated technique of port entry using the Killian nasal speculum. This technique has been used successfully in transperitoneal laparoscopic nephrectomy as well as extraperitoneal radical prostatectomy in our department. The Killian nasal speculum has an built-in light source allowing excellent vision, and its narrow "beak" perfectly separates the fat and rectus sheath, and allows muscle splitting without the need for any other instrument or assistant. This technique has been employed in obese patients, allowing easy access, and it creates a tight, leakproof entry port. The Killian nasal speculum is available in all hospitals that offer an ear, nose, and throat service, and comes in four different sizes and lengths to suit all types of patients.