Cannula Positioning

Although cannula placement is modified by additional procedures that may be performed, at least three cannulae are usually required for a thorough examination of the peritoneum, visceral organs, and retro-peritoneum (Figure 10.1.2). With improved optics, 5-mm videoscopes can be used for many procedures. If ultrasound is needed, at least one 10-mm additional cannula will be required, likely on the right side, because this will allow liver ultrasonography most easily. When diag-

* Optional

Figure 10.1.2. Cannula positions for the diagnostic laparoscopy. If liver ultrasound is used, the right cannula should be a 10-mm size (asterisk).

* Optional

Figure 10.1.2. Cannula positions for the diagnostic laparoscopy. If liver ultrasound is used, the right cannula should be a 10-mm size (asterisk).

nostic laparoscopy with or without biopsy is solely performed, we use a three-cannula technique (one cannula for a 5-mm 30°videoscope, a second for a 10-mm laparoscopic ultrasound, and a third for a 5-mm instrument). A 10-mm cannula is placed at the umbilicus and two additional 5-mm cannulae are placed in the right and left mid abdomen lateral to the rectus abdominus muscle. If a colectomy is anticipated, the cannula setup is altered according to the procedure to be performed. For example, if the colon is to be resected, we use a five-cannula technique with a 10-mm flexible videoscope. A 10-mm cannula is placed at the umbilicus, a 12-mm cannula in the lower quadrant opposite the segment of colon to be resected for the endoscopic stapler, and three additional 5-mm working cannulae in the other remaining abdominal quadrants.

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