Laparoscopy using the left upper quadrant as the primary trocar site.

Laparoscopic surgery was performed on 41 patients who were at high risk for subumbilical adhesions because of either previous midline incisions through the umbilicus or umbilical hernias. Insufflation was performed using a Veress needle placed in the left upper quadrant in the 9th intercostal space. The primary trocar was placed in the left upper quadrant adjacent to the subcostal margin. Sixty-eight percent (28/41) of patients had subumbilical adhesions. One patient required laparotomy because of an enterotomy created when an 11-mm trocar was used. There were no complications in the remaining 40 patients, in whom smaller primary trocars were used. This is a safe location for primary trocar placement in patients at high risk for subumbilical adhesions, provided certain guidelines are followed.