Table 2 Comparing laparoscopic insufflation with Veress needle insertion through the left upper quadrant and umbilicus
| Sub-costal, left upper quadrant | Umbilicus |
|---|---|---|
1 | Gaining popularity as the primary site for insufflation | Most common site to achieve pneumoperitoneum |
2 | Fixed parietal peritoneum to undersurface to costal margin | Risk of preperitoneal tenting and, hence, more failures |
3 | Less mobile and easy to stabilise abdominal wall near to costal margin or intercostal space | Abdominal wall needs either lifting or stabilisation prior to insertion of the Veress needle |
4 | Advantageous in obese patients due to less fat and thinner abdominal wall | Difficulty in insertion of the Veress needle due to more fat |
5 | Advantageous in very thin patients due to less risk of injury to major vessels | Potential risk of injury to abdominal aorta or iliac vessels |
6 | Chosen for patients with prior midline incision or peritonitis as there are rarely any adhesions | Increased incidence of adhesions from bowel or omentum |
7 | Chosen as an alternate site if pneumoperitoneum through the umbilicus failed | Can be used as an alternative site |
8 | Advantageous in large pelvic masses or gynaecological cancers | Potential risk of injury |
9 | Potential risk to left lobe of the liver, stomach, spleen and transverse colon | Potential risk to small bowel, major blood vessels and omentum |
10 | Hepatomegaly, splenomegaly, history of gastric or splenic surgery or palpable gastro-pancreatic mass should be regarded as contraindications to Veress needle placement | Large pelvic masses, previous midline incision and umbilical hernia should be regarded as contraindications |