diagnostic laparoscopy for adhesion zone, lavage cytology, biopsy sampling, second look operation

• Positioning is in lithotomy position, ideally on a large vacuum cushion or non-slip mat
• It is recommended to position both arms (caution: cotton wrapping when positioning with a cloth sling), or to position one arm on the assistant's side
• Positioning of the legs in leg holders
• The legs should be adjustable via the operating table control
• If necessary, shoulder supports bilaterally to prevent the patient from slipping on the operating table
• For longer procedures, application of pneumatic compression cuffs for the legs for thrombosis prophylaxis
• If necessary, attachment of a cervical adapter
• Insertion of a urinary bladder catheter

The trocar placement in the area of the Palmer's point (or Palmer point) is a technique used to minimize the risk of complications by avoiding injury to abdominal organs, especially in patients with previous surgeries or suspected intra-abdominal adhesions. This point is located in the left upper abdomen.

Small puncture incision 2–3 cm below the left costal margin and 1–2 cm medial to the left midclavicular line. Insertion with a Veress needle or a (mini) optical trocar: A Veress needle is inserted through the abdominal wall into the left upper abdomen to create the pneumoperitoneum (CO₂ gas insufflation).

Thus, Palmer's point is an important alternative to the classic umbilical trocar placement and offers a safer access option for certain high-risk patients or when adhesions in the lower abdomen are suspected.