Infraumbilical skin incision, transection of the subcutaneous tissue and exposure of the fascia
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Infraumbilical access
![Infraumbilical access]()
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Exposure of the umbilical orifice
![Exposure of the umbilical orifice]()
Soundsettings Whenever present, use the umbilical orifice for trocar insertion (as demonstrated in this video clip). To do so, circumvent the umbilicus with a finger or blunt instrument and expose its insertion at the level of the fascia. Here, the umbilicus is sharply dissected off its insertion, thereby exposing the umbilical orifice. Now clamp the edges of the fascia with Mikulicz clamps.
Tip:
In planned peritoneal dialysis, the umbilical orifice must be carefully closed because otherwise the dialysate instilled into the abdominal cavity may result in herniation. If there is no umbilical orifice which may double as trocar access, the latter is established as usual in laparoscopy.
Initiation of pneumoperitoneum and inspection of the abdominal cavity
Insert the trocar for the camera through a small incision of the peritoneum and establish the press
Insert the trocar for the camera through a small incision of the peritoneum and establish the press
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