Visual field obstruction in single-puncture operative laparoscopy.

The use of the laser for translaparoscopic surgery has brought with it a renewed interest in single-puncture operative laparoscopy. Concern about the extent of visual obstruction created intraoperatively by the use of ancillary instruments through the accessory channel prompted this evaluation. Under normal operative conditions, a 5-mm instrument protruding 10 mm or more beyond the distal end of the laparoscope will obstruct 14.6% of the operator's visual field. Still greater curtailment of endoscopic visualization can be expected when large, modified laser probes are used. The double-puncture laparoscopic technique must be considered the method of choice for translaparoscopic conventional or laser surgical procedures.