Placement of Accessory Ports

Selecting the insertion sites of working trocars is dependent on the procedure to be performed and also depends on the surgeon's preference, the patient's body habitus, and the presence or absence of previous scars or intra-abdominal adhesions.

The Steps

■ The size of the skin incision must be planned carefully. If the incision is too small, friction will develop between the skin and the port, and greater force will be required for insertion, which will increase the risk of uncontrolled insertion. If the incision is too large, gas may leak and the port may dislocate more easily

■ Transillumination of the skin can help to avoid cutting through major blood vessels (A-1)

■ The trocar is optimally inserted by holding it between the index and the middle fingers. The shaft of the trocar should also be supported by the opposite hand as the body wall is traversed (A-2)

A-2

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