Use of Palmer's Point for Insertion of the Operative Laparoscope in Patients with Severe Pelvic Adhesions: Experience of Seventeen Cases

Seventeen patients who had known or suspected intra-abdominal adhesions underwent laparoscopic surgery with the use of Palmer's Point for insertion of the operative laparoscope. Five of them were found to have extensive periumbilical adhesions. Intestinal or omental injury can occur if the trocar is inserted directly through the umbilical fossa. Though the incidence of direct trauma is reportedly low, there were still mild to moderate omental adhesions to the anterior abdominal wall, as we expected, in the remaining 12 patients. Possible inadequate aspiration and irrigation during laparoscopic removal of a dermoid cyst in one woman had resulted in severe postsurgical intraabdominal adhesions. More than two 10 mm incisions were used in our patients for insertion of the laparoscope interchangeablely to facilitate the procedure of laparoscopic adhesiolysis. The operative field can be expanded greatly. Fourteen patients completed the laparoscopic surgery, and the other 3 had alternative procedures eventually. No complications occurred during the laparoscopic procedure. The postoperative courses were uneventful in all 17 patients. Our experience suggests that Palmer's Point is a good alternative for insertion of the Veress needle and laparoscope in patients with previous laparotomies and suspected severe pelvic adhesions.