TY  - CHAP
M1  - Book, Section
TI  - HASSON OPEN TECHNIQUE FOR LAPAROSCOPIC ACCESS
A1  - Ellison, E. Christopher
A1  - Zollinger, Robert M.
PY  - 2016
T2  - Zollinger's Atlas of Surgical Operations, 10e
AB  - The  first  step  in  most  abdominal  laparoscopic  procedures  is  insufflation  of  the  intraperitoneal  space  with  CO2  gas  and  the  introduction  of  the  videoscope  system.  The  original  and  the  most  established  technique  uses  the  Veress  needle,  described  in  the  following  Chapter  12.  The  Veress  needle  can  be  placed  in  any  quadrant  of  the  abdomen,  but  is  most  frequently  inserted  just  below  the  umbilicus,  where  a  skin  incision  has  been  made  for  the  introduction  of  a  large  10-mm  port  for  the  videoscope.  General  surgeons,  however,  have  been  cautious  in  adopting  this  technique  of  blind  puncture,  as  their  training  has  emphasized  the  importance  of  complete  visualization  of  anatomy  and  of  the  planned  action  of  their  surgical  instruments.  Accordingly,  the  open  or  Hasson  technique  for  entering  the  abdomen  under  direct  vision  has  become  more  popular  and  safer.  This  technique  can  be  used  to  enter  into  any  quadrant  of  the  abdomen  but  is  most  commonly  employed  at  the  central  umbilical  site  (figure  1).  A  vertical  or  transverse  skin  incision  approximately  10  to  12  mm  in  length  is  made  just  below  (figure  2)  or  above  the  umbilicus.  The  choice  of  site  may  be  based  on  the  surgeon’s  preference  or  the  presence  of  a  previous  regional  incision  that  may  have  adhesions.  The  subcutaneous  fat  and  tissues  are  bluntly  dissected  apart  using  small  narrow  finger  retractors  or  a  Kelly  hemostat.  The  white  linea  alba  is  visualized  and  grasped  on  either  side  with  hemostats.  The  linea  alba  is  elevated  with  the  hemostats  and  a  vertical  10-mm  incision  is  made  through  the  fascia  (figure  2).  Further  dissection  with  a  hemostat  will  reveal  the  thickened  white  peritoneum,  which  is  grasped  with  a  pair  of  laterally  placed  hemostats.  The  peritoneum  is  elevated  and  opened  cautiously  with  a  scalpel.  A  dark,  empty  peritoneal  space  is  seen  and  a  pair  of  lateral  stay  sutures  are  placed  (figure  3).  These  sutures  incorporate  the  peritoneum  and  linea  alba  and  are  later  used  to  secure  the  Hasson  port.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1127271670
ER  -