Peritoneal hyperdistention for trocar insertion

Introduction Most laparoscopic complications occur at the time of Veress ne edle and trocar insertion. Although they are not very frequent, they increa se the morbidity and mortality of both diagnostic and operative laparoscopi c procedures. The currently recommended techniques of trocar insertion have not completely eliminated the risk of injury. Technique After Veress needle insertion we recommend creating peritoneal hy perdistention up to 25-30 mmHg pressure. At this point a short trocar is in serted in the deepest part of the umbilicus without elevation of the anteri or abdominal wall. The result is a parietal peritoneal puncture directly be neath the umbilicus. As soon as safe abdominal entry is established, the pr essure is lowered to 15 mmHg. Experience In our large series utilizing peritoneal hyperdistention there w as but one vascular bowel injury related to umbilical trocar insertion. Mai ntaining an increased intra-abdominal pressure for the length of time requi red for trocar insertion did not result in patient morbidity. Conclusion Peritoneal hyperdistention at trocar insertion is safe and may r educe the rate of trocar-related complications.