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Settings and Design: This prospective observational study was conducted in three parts in Surgery-II, Department of Surgery, GTBH-UCMS, Delhi.
Materials and Methods : In part one, skin fold thickness (SFT) was measured in 32 patients at SUF, LICS, right iliac fossa (RIF) and Palmer's point.
At this time, observations regarding ease of insertion, number of attempts required to position the needle in the peritoneal cavity, intra-abdominal bleed from the site of VNI, hemopneumothorax and position of the needle with respect to transverse colon were made.
Clinical examination was relied upon to look for hemopneumothorax.
Once again, the technical details as mentioned below (see section 'technique of VNI through LICS' below) were followed strictly.As part two, in these patients, VNI was carried out from LICS under laparoscopic guidance.As part three, same technique of VNI was employed in 43 patients with suspected intra-abdominal adhesions undergoing laparoscopy for various reasons.Also, the peritoneal cavity was inspected to look for adhesions due to previous surgery or disease as this was the primary reason for creating pneumoperitoneum from an alternate route.If present, the adhesions were broken down with the help of other trocar and endo-scissors.
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Unsuspected intra-abdominal adhesions, especially due to tuberculosis, are not uncommon in tropical countries, and may virtually rule out the use of Palmer's point and RIF for VNI.