Palmer's Point Versus The Umbilicus As Routine Primary Entry Site In Gynecologic Laparoscopy
Palmer's Point Versus The Umbilicus As Routine Primary Entry Site In Gynecologic Laparoscopy
we will compare the classic method of using the umbilicus as the primary entry site in
 gynecological laparoscopy with Palmar's point
All these cases will undergo:

 1. History taking Patients are randomly arranged in 2 groups Group (A):- Palmer's point is
 the primary entry site. The stomach will be emptied of secretions and air following
 endotracheal intubation. (This is most easily performed using a nasogastric tube.) The left
 upper quadrant will be inspected for scars and the upper abdomen palpated for hepatomegaly or
 splenomegaly. A 10-mm incision will be made over Palmer's point. Veress needle first will be
 used for insufflation and tests of safety will be considered.

 A 10-mm port will be held vertically and the layers observed via a 10-mm laparoscope. A
 gentle rotating action in a vertical direction was used to allow the bladeless tip to
 separate the tissues.

 The layers of the abdominal wall seen at Palmer's point are as follows:

 -  skin,

 -  subcutaneous fat,

 -  external oblique aponeurosis,

 -  internal oblique aponeurosis,

 -  transversalis muscle fibres,

 -  (sometimes) extraperitoneal fat,

 -  peritoneum. Once the peritoneum will be breached, the introducer will be carefully
 removed from the port. The laparoscope will be then reintroduced.

 An extra 360° check was then performed to exclude a through-and-through bowel injury. The
 umbilicus was then inspected and any adhesions cleared using one or more 5-mm ports inserted
 under direct vision. At the end of the operation, the skin was closed using a single
 subcuticular suture Group (B):- The umbilicus is the primary entry site. First of all, the
 umbilicus is well cleaned with a piece of gauze with betadine or alcohol then small incision
 is done (10mm) in the umbilicus, veress needle is then inserted and tests of safety of
 intraperotineal insufflation are considered. 10 mm port is then introduced with gentle
 rotating action in a vertical direction to allow the bladeless tip to separate the tissues.

 The layers of the abdominal wall seen at Palmer's point are as follows:

 -  skin

 -  linea alba

 -  peritoneum. Once the peritoneum is breached, the trocar will be carefully removed from
 the port. The laparoscope will then reintroduced.

 An extra 360° check was then performed to exclude a through-and-through bowel injury. At the
 end of the operation, the skin will be closed using a single subcuticular suture
Inclusion Criteria:

 -  Patients listed for diagnostic or operative laparoscopy.

 Exclusion Criteria:

 -  • Splenomegaly

 -  Hepatomegaly

 -  previous left upper quadrant surgery.

 -  midline laparotomy

 -  umbilical surgery

 -  presence of umbilical hernia