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Two methods are used for establishing abdominal access during laparoscopic
procedures.
The first, direct puncture laparoscopy, begin with elevation of the relaxed abdominal wall
with two towel clips or a well placed hand. Small incison made in umbilicus, and a
specialized spring-loaded (veress) needle, two distinct pop are felt as the surgeon passes
the needle through the abdominal wall fascia and peritoneum
Direct peritoneal access (Hasson) technique advisable. With this technique surgeon
makes a small incision just below the umbilicus and under direct vision locates the
abdominal fascia. Two Kocher clamps are placed on the fascia, with curve mayor
scissors, a small incision made through the fascia and underlying peritoneum.
Access for Subcutaneus and
extraperitoneal surgery
There are two methods for gaining access to
nonatomic spaces. For retroperitoneal
locations, balloon dissection is effective.