Are we underutilizing Palmer's point entry in gynecologic laparoscopy?

OBJECTIVE: To report our experience using Palmer's point entry in women undergoing gynecologic laparoscopic surgery. DESIGN: Retrospective observational study. SETTING: University teaching hospital, London, United Kingdom. PATIENT(S): We reviewed all patients who underwent laparoscopic gynecologic surgery under the care of the senior author between January 1, 2005, and December 31, 2008. INTERVENTION(S): Gynecologic laparoscopic surgery. MAIN OUTCOME MEASURE(S): Indications, incidence, success, and complications of using Palmer's entry. RESULT(S): Three hundred eighty-five patients underwent laparoscopic surgery. We used umbilical entry in 249 (64.6%) and Palmer's entry in 136 (35.4%). In almost three fourths of cases, the indications for using Palmer's point were previous laparotomy or the presence of large uterine fibroids. The next most common reasons for choosing Palmer's point were known documentation of intra-abdominal adhesions from prior laparoscopies, large ovarian cysts, and hernias or hernia repairs. Entry via Palmer's point was successful in all but two cases (98.5%), and there were no entry-related complications. CONCLUSION(S): Our experience shows that laparoscopic entry using the left upper quadrant is safe with a low failure rate. Because the vast majority of gynecologic laparoscopies are done using subumbilical entry, it seems that Palmer's entry is underused by many gynecologists, despite it being safer in patients at risk of underlying adhesions and more appropriate in the presence of a large pelvic mass or a nearby hernia.