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. 2022 Jul-Sep;15(3):300-306.
doi: 10.4103/jhrs.jhrs_70_22. Epub 2022 Sep 30.

E-Z Point: A New Safe and Reproducible Laparoscopic Entry in the Left Upper Quadrant Using a Veress Needle

Ghadear Shukr  1 , Madeleine R Gonte  1   2   3 , Victoria E Webber  1   2 , Omar Zwain  1 , David Eisenstein  1
Affiliations

E-Z Point: A New Safe and Reproducible Laparoscopic Entry in the Left Upper Quadrant Using a Veress Needle

Ghadear Shukr et al. J Hum Reprod Sci. 2022 Jul-Sep.

Abstract

Background: Over half of all fatal complications occur during primary laparoscopic entry. In our practice, we developed a novel modification of closed LUQ entry at Palmer's point and designated it "E-Z" entry.

Aims: To evaluate the risks and safety of left subcostal entry, a technique we have designated 'E-Z' entry at our institution.

Settings and design: A retrospective chart review was conducted at a tertiary care medical centre of patients who underwent laparoscopic procedures by a single surgeon known to perform left subcostal entry for the last 10 years, using the E-Z entry technique.

Materials and methods: Retrospective chart review and description of surgical technique.

Statistical analysis used: Simple descriptive statistics and univariate two-group comparisons.

Results: One hundred ninety-eight laparoscopic cases were identified as performed by a single surgeon in the last 10 years: 149 underwent umbilical entry and 49 underwent E-Z entry. The average number of previous abdominal surgeries was higher in the E-Z entry group compared to the umbilical group, 1.3 versus 0.5, respectively (P = 0.003). The umbilical entry group had no complications. One complication was noted with the E-Z entry technique, in which the Veress needle was noted to perforate the liver capsule but was managed expectantly.

Conclusion: We propose the E-Z entry technique for Veress needle entry as an ergonomic and easily reproducible entry technique in the left upper quadrant in the setting of suspected intraperitoneal adhesions.

Keywords: E-Z point; Palmer's point; Veress needle; laparoscopic entry; left upper quadrant; minimally invasive gynaecologic surgery; umbilical entry.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
(a and b) E-Z point marked at the left upper quadrant at the intersection of the subcostal margin (solid line) and midclavicular line (dashed line)
Figure 2
Figure 2
Veress needle in the intraperitoneal space from the perspective of the umbilical point
See this image and copyright information in PMC

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