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Is Palmer’s Point Really Safe? Shir Dar, MD, MHA, Tal Lazer, MD, Ari Baratz, MD, FRCSC Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON CReATe Fertility Centre, Toronto ON
39-year-old woman presented with primary infertility and a history of recurrent sexually transmitted infections. At a previous laparoscopy, at which the Veress needle was inserted at the umbilicus, bleeding at the umbilical port site had required cautery and suturing for hemostasis. Bilateral hydrosalpinges were also noted. Prior to an IVF cycle, bilateral salpingectomy was planned. At laparoscopy, Palmer’s point (3 cm below the left subcostal margin in the mid-clavicular line) was used for insertion of the Veress needle.1 Moderate omental adhesions at the level of the umbilicus were seen. Unexpected adhesions were also noted when the port site at Palmer’s point was inspected (Figures 1 and 2).
Insertion of the Veress needle at Palmer’s point is considered safe in patients with peri-umbilical adhesions2; however adhesions at Palmer’s point may still be found. REFERENCES 1. Vilos G, Temamian A, Dempster J, Laberge PY; SOGC Clinical Practice Gynaecology Committee. Laparoscopic entry: a review of techniques, technologies, and complications. Clinical practice guideline no. 193, May 2007. J Obstet Gynaecol Can 2007;29(5):433–47. 2. Molloy D, Kaloo PD, Cooper M, Nguyen TV. Laparoscopic entry: a literature review and analysis of techniques and complication of primary port entry. Aust N Z J Obstet Gynaecol 2002;42:246–54.
J Obstet Gynaecol Can 2013;35(12):1063
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