Majority of LC were performed by using a modified three port technique called sectorization rather than triangulation with 10 mm umbilical camera port a 5mm dissecting port 4-5 cm below xiphoid sternum and a third 5mm port in left rather than right
midclavicular line 10-15 cm away from umbilicus for holding Hartmann's pouch in most of the cases.
(9), between the anterior axillary line and the
midclavicular line beyond the insertion of serratus anterior, and on the ventral surface of the left forearm.
Generally, it can be suspected if the liver measures more than 16 cm in length at the
midclavicular line on the AP lumbar radiograph and extends below the level of the iliac crest.
Two smaller ports for grasping instruments were then placed, one in right upper quadrant near the
midclavicular line and second just medial to anterior axillary line.
In the 1940s, the French gynecologist Raoul Palmer advocated placing the laparoscope at a point in the left
midclavicular line, approximately 3 cm caudal to the costal margin, because visceral-parietal adhesions rarely were found there.
Five ports (ENDO PATH Xcel, Ethicon Endo-Surgery, LLC, USA) including three 12 mm ports are positioned, one supraumbilical port, two in the right and left
midclavicular line, and two 5 mm ports in the right and left anterior axillary line as described previously [17], but there has been a decrease in the number of ports with more experience.
The probe was placed perpendicular to the ribs in the anterior chest region intercostal spaces 2-3 along the
midclavicular line. This was usually done at 3rd-4th intercostal spaces.
Liver span was measured in the
midclavicular line. The liver was also examined for smoothness of surface, echogenicity, and posterior attenuation of the sound beam and portal vein diameter outside the liver midway between its entrance into the portal hepatic vein and its first bifurcation in the liver.
Four ports were placed; a 10-mm trocar in the umbilicus, a 12-mm trocar in the left
midclavicular line (right hand working port), a 5-mm trocar in the right
midclavicular line and a 5-mm trocar under the xiphoid for liver retraction.
In physical examination, a suturated wound of 1.5 cm on the right
midclavicular line was observed.
The abdomen was explored via a generous subcostal incision extending from the left anterior axillary line to the right
midclavicular line. Engorged paraumbilical veins and abdominal wall varices were encountered and ligated to preserve hepatopetal flow (Fig.