Indications
Placement of a Hasson cannula is a widely used technique in all laparoscopic (i.e., minimally invasive or keyhole) surgery. It allows the surgeon to place the first large port used to insufflate (fill with air) the peritoneal cavity to allow visualization of intraabdominal and pelvic structures and to allow safe placement of the operating ports and equipment under direct visualization.
Although most commonly placed in the periumbilical midline (i.e., belly button) area, this technique can be used to enter the abdomen on the midline away from the umbilicus or off the midline through the rectus muscle.
Contraindications
Placement through a previously placed prosthetic mesh.
Placement through an area of dense adhesions.
Surgical Details of Procedure
1. Small incision is made vertically in the periumbilical area through the skin and into the subcutaneous tissue.
2. Army Navy or S retractors are used to bluntly dissect the subcutaneous tissue until the rectus fascia is appreciated.
3. Two 2-0 Vicryl stay sutures are placed into fascia on either side of the planned area of fascia incision.
4. A 15 blade is used to make a vertical incision in the fascia.
5. Hemostats are used to bluntly dissect the supraperitoneal tissue away from the peritoneum.
6.. The peritoneum is grasped with two forceps and incised with a knife – this should expose the peritoneal cavity.
7. Finger dissection is done circumferentially around the opened peritoneum to bluntly dissect away adhesions.
8. The Hasson cannula is placed into the peritoneal cavity and the 2-0 Vicryl stay sutures in the fascia are wrapped around the Hasson cannula hubs to secure it in place.
9. The camera is placed through the Hasson cannula to ascertain that the cannula is truly in the abdominal cavity.
10. The connecting tube to the carbon dioxide tank is connected to the Hasson cannula port to start insufflation of the peritoneal cavity to 15 mmHg’s.