Image Tag: Fundamentals

Tubing Placement

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

Hasson Cannula

Open (Hasson) cannula, reusable type.

Trocar Sites

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.

Insufflator Readings

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.

Insufflator testing.

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.

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