Laparoscopic and Robotic Access

Access may often be overlooked or minimized as an integral part of any laparoscopic case. However, difficulty or error in obtaining proper access can prove disastrous in its consequences for both the surgeon and the patient. This chapter details safe and reliable techniques used to gain laparoscopic access into the abdominal cavity, including both open and closed access. Each method is reviewed, along with the advantages and disadvantages of each. Tips for confirmation of successful entry into the peritoneal cavity are included. In addition, the complications associated with laparoscopic access, both immediate and delayed, are examined. More importantly, the recognition and management of these complications are outlined. The various types to trocars are discussed, along with the characteristics of each that may influence surgeon preference. Finally, the process of exiting the abdomen is explained, as well as when and how to close laparoscopic port sites.