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laparoscopy entry techniques

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Case 62 - A 35-Year-Old P2 Woman with Preperitoneal Insufflation at Time of Laparoscopy
- By Frances Burgan
Edited by Todd R. Jenkins, University of Alabama, Birmingham, Lisa Keder, Abimola Famuyide, Kimberly S. Gecsi, David Chelmow
Book:

Surgical Gynecology

Published online:

19 November 2021

Print publication:

02 December 2021, pp 189-190
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Summary

A 38-year-old para 2 presents for scheduled total laparoscopic hysterectomy for heavy menstrual bleeding. She has no past medical history. Her past surgical history is significant for two low transverse cesarean sections. She is not taking any medications and she has no known drug allergies. Laparoscopic entry is started with a Veress needle inserted through a small incision in the skin of the umbilicus until two popping sounds are heard. Aspiration in the space is negative. A hanging drop test is slow but the saline flows in. The gas source is connected and the pressure at the tip of the Veress needle reads 10 mmHg. Insufflation is begun at 1 L/min and a sharp trocar is inserted once the pressure becomes 20 mmHg. Upon entry of the laparoscope, distended fat is visualized instead of intraperitoneal contents.