Ultrasound-Guided Access into the Abdomen in the Setting of Portal Hypertension: A Novel Technique.

As the field of minimally invasive surgery rapidly evolves, there is an opportunity to adopt innovative techniques to accommodate a variety of patient populations. In patients with portal hypertension, a major risk factor upon entry into the abdomen is injury to large, engorged paraumbilical vessels in the anterior abdominal wall. Major blood loss often results from just entering the abdomen. Here, we describe a patient with caput medusae secondary to portal hypertension presenting for laparoscopic repair of a ventral hernia. Using ultrasound guidance, initial port placement into the abdomen was performed safely using needle access, Seldinger technique, and serial dilation for VersaStep™ 5 mm port (Medtronic, Minneapolis, MN) insertion. Overall, this innovative technique is a safe and effective method of entry into the abdomen in a patient with portal hypertension.