{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T02:43:13Z","timestamp":1773196993987,"version":"3.50.1"},"reference-count":15,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,1,6]],"date-time":"2022-01-06T00:00:00Z","timestamp":1641427200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Asian J Endoscop Surgery"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Laparoscopic bariatric surgery (BS) is not readily performed in Japan. To facilitate safe initial access to the abdominal cavity, we insert an optical viewing trocar at a unique site in the left upper quadrant (LUQ). Herein, we describe the technique, its advantages, and outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Surgical Technique<\/jats:title><jats:p>Briefly, the optical trocar is inserted just below the left subcostal margin, 8\u00a0cm from the midline. On insertion, layers of the abdominal wall are visualized on the monitor. Depending on the angle of insertion, five, seven, or eight layers are seen.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>In assessing our initial entry technique, used in 21 obese patients undergoing laparoscopic sleeve gastrectomy, we found median insertion time to be 25\u2009seconds. There were no related complications. In nearly all (20\/21) patients, the abdominal wall was visualized as seven layers: subcutaneous fat, anterior rectus sheath, rectus abdominis muscle, posterior rectus sheath, transverse abdominis muscle, transversalis fascia, and peritoneum. Understanding the layers of the abdominal wall visualized during optical trocar insertion in the LUQ will provide for safe and rapid initial entry in patients undergoing laparoscopic BS and can further the widespread acceptance of laparoscopic BS.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ases.13019","type":"journal-article","created":{"date-parts":[[2022,1,7]],"date-time":"2022-01-07T04:34:40Z","timestamp":1641530080000},"page":"463-466","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Initial entry via the left upper quadrant with an optical trocar in laparoscopic bariatric surgery"],"prefix":"10.1111","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0989-8577","authenticated-orcid":false,"given":"Manabu","family":"Amiki","sequence":"first","affiliation":[{"name":"Kawasaki Saiwai Hospital  Kawasaki City Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasuhiro","family":"Ishiyama","sequence":"additional","affiliation":[{"name":"Kawasaki Saiwai Hospital  Kawasaki City Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatsunosuke","family":"Harada","sequence":"additional","affiliation":[{"name":"Kawasaki Saiwai Hospital  Kawasaki City Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ichitaro","family":"Mochizuki","sequence":"additional","affiliation":[{"name":"Kawasaki Saiwai Hospital  Kawasaki City Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuki","family":"Tomizawa","sequence":"additional","affiliation":[{"name":"Kawasaki Saiwai Hospital  Kawasaki City Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shingo","family":"Ito","sequence":"additional","affiliation":[{"name":"Kawasaki Saiwai Hospital  Kawasaki City Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masataka","family":"Oneyama","sequence":"additional","affiliation":[{"name":"Kawasaki Saiwai Hospital  Kawasaki City Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshiaki","family":"Hara","sequence":"additional","affiliation":[{"name":"Kawasaki Saiwai Hospital  Kawasaki City Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazuhiro","family":"Narita","sequence":"additional","affiliation":[{"name":"Kawasaki Saiwai Hospital  Kawasaki City Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuji","family":"Tachimori","sequence":"additional","affiliation":[{"name":"Kawasaki Saiwai Hospital  Kawasaki City Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manabu","family":"Goto","sequence":"additional","affiliation":[{"name":"Kawasaki Saiwai Hospital  Kawasaki City Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koji","family":"Sekikawa","sequence":"additional","affiliation":[{"name":"Kawasaki Saiwai Hospital  Kawasaki City Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Motoko","family":"Kuba","sequence":"additional","affiliation":[{"name":"AOI Universal Hospital  Kawasaki City Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,1,6]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/ases.12836"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.29271\/jcpsp.2020.01.85"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-016-2080-9"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLE.0b013e31828f6cfd"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-020-04435-1"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-005-0188-4"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-005-0823-0"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.soard.2009.05.010"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.4293\/JSLS.2017.00101"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-017-5536-7"},{"key":"e_1_2_9_12_1","unstructured":"Japan Society for Endoscopic Surgery.15th Nationwide Survey of Endoscopic Surgery in Japan. 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