Double Laparoscopy: An Alternative Two-Stage Procedure to Minimize Bowel and Blood Vessel Injury

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Abstract
We present double laparoscopy as an alternative technique especially useful with the scarred abdomen postlaparotomy or when open laparoscopy has failed. This is a two-stage abdominal endoscopic procedure. Stage 1. This is the establishment of a pneumoperitoneum with insertion of a Verres needle through the left upper quadrant of the abdominal wall lateral to the rectus muscle, two fingers beneath the inferior costal margin. A sharp 5 mm trocar and sleeve is inserted through a small skin incision at the needle puncture site, and a small endoscope is then inserted. The hysteroscope or a 5 mm OD diagnostic laparoscope is an excellent instrument for upper abdominal laparoscopy in the adult and for general laparoscopy in infants and children. The abdominal cavity is surveyed, especially viewing the periumbilical area. Stage 2. When an adhesion-free and bowel-free area is identified, a standard 10 mm sharp trocar and sleeve is inserted under direct vision, and a standard laparoscope is introduced. We present a small sampling (24 cases) of our combined experience of 5000 laparoscopies, where this technique proved useful. Although we have used this technique over the years without any complications, the procedure has never been published.

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