Preventing organ injury during the first punctures: Lee-Huang point for giant tumors and Palmer's point for umbilical adhesion

Introduction: Gynecologic laparoscopy often involves making the first puncture in the umbilicus. However, such punctures may injure organs in patients with large uterus or ovaries reaching the umbilicus, or the omentum or intestine adhering to the umbilicus in patients with previous abdominal surgery. To avoid such complications, we make the first puncture at Lee-Huang point for giant tumors and Palmer's point when umbilical adhesion is suspected.Technique: [Lee-Huang point] In cases with giant tumor, the first puncture is made at Lee-Huang point, the midpoint between the umbilicus and xiphoid process. Making the first puncture at Lee-Huang point and using it as the camera port. It helps avoid organ injury and ensure an intraoperative visual field.[Palmer's point] In cases with suspected umbilical adhesion, the first puncture is made at Palmer's point, 3 cm below the costal margin on the midclavicular line. Discussion: We make the first puncture at Lee-Huang point or Palmer's point in case with high risk, such as giant tumor or adhering. Guidelines from the Society of Obstetricians and Gynaecologists of Canada state that in patients with suspected umbilical adhesion, open entry increases the risk of small intestine perforation; therefore, a Palmer's point approach is recommended.Conclusion: We can perform the operation with making the first puncture at Lee-Huang point and Palmer's points without the associated complications.