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Photograph taken through the trocar sheath during laparoscopy identifying a solid sheet of dense adhesions binding omentum and bowel directly to the inner abdominal wall immediately adjacent to the trocar’s insertion site. Trauma to the adherent structures is certainly possible during placement of these laparoscopic instruments and great care should be exercised by the surgeon to limit the patient’s exposure to the risk of injury. In women with a prior surgical history that suggests an increased possibility of these sorts of adhesions, I generally enter the abdomen superior to (above) the previous insertion sites and may use instruments that allow direct visualization during the initial entry.
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