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

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.