Infiltration Technique Descriptions
Laparoscopic Abdominal Port Site Placement Infiltration Technique
Under direct laparoscopic visualization, transilluminate the proposed trocar placement site(s) to help avoid injury of underlying vessels. Slowly inject local analgesic into the dermis to raise a wheal.
2) Infiltration of preperitoneal space:
Under direct visualization, aspirating to confirm there is no blood, advance the needle in a perpendicular fashion to the preperitoneal space. This is visualized by tenting of the peritoneum* (see Figure 2). A blunt needle will help avoid needle puncture through the peritoneum.
3) Deep infiltration of trocar tract:
Slowly withdraw the needle to the dermis level while infiltrating the abdominal wall layers (preperitoneal space, posterior abdominal fascia, abdominis muscle, anterior abdominal fascia, subdermis and dermis). Pay special attention to placing local analgesic deep to the anterior abdominal fascia/into the subfascial plane utilizing the sensation of a "pop" or "feel" as the needle passed through the different layers of the abdominal wall.
Peritoneal, myofascial and cutaneous sensory nerves along the anticipated trocar insertion tract
2-3 cc per trocar site
Preperitoneal space and peritoneal nerves at the anticipated trocar placement site(s)
0.5-1 cc per trocar site
Infiltration Target
1) Infiltration of dermis and subcutaneous tissue at trocar site(s):
Cutaneous sensory nerves at the trocar placement site(s)
0.5-1 cc per trocar site
Local Analgesic Volume
TOTAL: 3-5 cc per trocar site
Figure 2. Laparoscopic View of Peritoneum
Tenting caused by needle*
* Once tenting is noted, keep the camera focused on this area to ensure placement of the trocar is directly through the area infiltrated with local analgesic.
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