Laparoscopic surgical access in morbidly obese women undergoing endometrial cancer surgery: Repurposing the left upper quadrant approach

Optimizing first trocar access for robot‐assisted radical prostatectomy: Optical trocar access through the upper abdominal quadrant using the Kii Fios First Entry trocar

“…Gas leakage from the pneumoperitoneum, a serious problem with the open method, is also resolved, and the risk of vascular and bowel damage due to blind manipulation, which is a problem with the Veress method, is reduced. These advantages have allowed successful treatment of difficult cases, including patients with severe obesity and previous abdominal surgery 8,17,18,22,23 . In our study, we could reach the abdominal cavity through an incision made very close to the abdominal wall.…”

“…However, in the area around the umbilicus, preperitoneal fat and intra‐abdominal fat tissue are difficult to distinguish, and the round ligament of the liver must also be considered. The upper abdominal quadrant, particularly on the left side, is in almost the same position as Palmer's point, where Veress needle insertion is appropriate 12,18 . Anatomically, the upper abdominal quadrant is easier to recognize than the umbilicus (Figure S2).…”

“…Although the safety and efficacy of first trocar placement during laparoscopic and robotic surgeries appear well‐established, some controversy remains 5‐16,18,19 …”

“…We used the Kii Fios First Entry trocar to deliver CO 2 through a small hole made by the trocar tip (Figure 1B). Conventional OTA usually requires the surgeon to lift the abdominal wall with the hand or towel forceps 10,12,16,18,22,23 (Figure 1A). However, air can enter the abdominal cavity when lifting the abdominal wall.…”

Obesity as a risk factor of in-hospital outcomes in patients with endometrial cancer treated with laparoscopic surgical mode

“…Minimal abdominal invasive surgery may be challenging or hazardous in the case of overweight or obese subjects, especially when endometrial cancer is combined with abdominal obesity. The left upper quadrant entry can be a safe, reliable alternative for entry through the umbilical area in high-risk patients [27]. Greater waist circumference as well as BMI were noted in patients who experienced procedure-related complications.…”