Diagram demonstrating the placement of flexible tubing or wire in combination with low-pressure pneumoperitoneum: (A) Banting et al. (1993), (B) Inoue et al. (1993), (C) Go et al. (1995). These techniques can be adapted using readily available materials a
Bleeding From Trocar Site
A. Bleeding from a trocar site. B. Cantilevering the sheath into each quadrant to find a position that causes the bleeding to stop. When the proper quadrant is found, pressure from the portion of the sheath within the abdomen tamponades the bleeding ve
Bleeding From Abdominal Wall
A. Retractors expose peritoneum. B. Peritoneum is elevated and sharply incised. Two fascial sutures are secured to the struts on the sheath of the open cannula. The cone-shaped sleeve is then pushed firmly into the incision and the setscrew is tightene
Open (Hasson) cannula, reusable type.
Optional trocar sites in previously operated abdomen. Consider the open-cannula technique.
Insufflator Readings – 2
At 15mmHg intra-abdominal pressure, 3 to 6L of CO2 will usually have been insufflated; the registered flow should then fall to 0.
After 1L has been insufflated, the set flow is increased to the highest rate.
Initial insufflation readings:
proper inflow at beginning of CO2-Veress needle insufflation.
Testing retractable tip of disposable Veress needl
A. Blunt tip retracts as it contacts resistance (e.g., a knife handle). B. When the needle is pulled away from the point of resistance, the blunt tip springs forward and protrudes in front of the sharp edge of the needle.
With the insufflation tubing kinked, the intraabdominal pressure should rapidly rise (e.g., 30mmHg), thereby exceeding the preset 15mmHg pressure set point. The flow of CO2 should immediately cease (0 L/min) and an alarm should sound.
With insufflator tubing open (i.e., not connected to Veress needle) and flow rate set at 6 L/min, the intra-abdominal pressure reading obtained through the open insufflation line should be 0mmHg