Access to the Preperitoneal Space and Port Placement

• A 10 mm infraumbilical incision is made and the anterior rectus sheath is incised just lateral to the midline (Figure G). The linea alba should not be divided so as to prevent entrance into the peritoneal cavity. S-retractors are used to retract the rectus muscle laterally (Figure H).
• A balloon dissector is placed along the anterior surface of the posterior rectus sheath and advanced inferiorly past the arcuate line (line of Douglas), where the posterior sheath ceases to exist, to the level of the pubic bone (Figure I). Generally, placing the patient in a mild degree of Trendelenberg will facilitate proper placement of the balloon dissector. The end of the balloon dissector is palpable at the level of the pubis.

Reprinted from "Atlas of Minimally Invasive Surgery, Jones et al, Copyright Cine-Med, Inc. 2006."