suspected malignant ascites.

uncorrectable coagulopathy.

significant abdominal wall infection.

hemodynamic instability.

extensive prior abdominal or pelvic surgery.

Intestinal obstruction with intention to treat

Massive hemoperitoneum

Generalized peritonitis

Extensive prior abdominal or pelvic surgery

Abdominal wall infection

a 3-day mechanical bowel preparation if an extraperitoneal or retroperitoneoscopic approach is anticipated.

for most uncomplicated patients, a clear liquid diet and a light mechanical bowel preparation the day before surgery.

a mechanical bowel preparation and antibiotic preparation with Neomycin and metronidazole.

both an antibiotic and 3-day mechanical bowel preparation in patients who have had previous abdominal surgery if one anticipates encountering dense intra-abdominal adhesions.

intravenous antibiotics 1 hour before surgery.

In patients with chronic respiratory disease, CO2 is advantageous because it does not accumulate in the bloodstream.

Nitrous oxide has previously been used for insufflation; however, it is no longer routinely used because of the potential for intra-abdominal explosion.

CO2 as an insufflant can be dangerous because it can support combustion.

CO2 is most commonly used because it is insoluble in the blood.

Argon gas would be an ideal insufflant owing to its low cost and poor solubility in blood.

a.5mmHg.

10 mm Hg.

15 mm Hg.

20 mm Hg.

25 mm Hg.

Open access technique

Gasless technique

Hand-port access

Closed technique with Veress needle

Closed technique with blind trocar insertion

TissueLink device

LigaSure device

Harmonic shears

Monopolar hook electrode

Bipolar scissors

Hem-o-Lok plastic clips

Endo GIA with 4.8-mm staples

5-mm LigaSure

Titanium clips

Endo GIA with 2.5-mm staples

Use of a high-speed morcellator

Scissor morcellation

Kelly clamp

Ultrasonic tissuetripsy

Ring forceps

10- to 12-mm nonbladed ports placed on the midclavicular line

5-mm nonbladed ports

10- to 12-mm nonbladed ports placed on the anterior axillary line

10- to 12-mm nonbladed ports placed on the midline

5-mm bladed ports

12 mm Hg

15 mm Hg

21 mm Hg

18 mm Hg

24 mm Hg

Increase in disturbances of gastrointestinal motility

Decrease in urinary output

Increase in diaphragmatic motion

Increase in mesenteric vessel blood flow

Alkalosis

20% morbidity, 0.5% mortality

13% morbidity, 0.2% mortality

20% morbidity, 0.8% mortality

2% morbidity, 0.8% mortality

25% morbidity, 0.8% mortality

Bowel injury

Liver injury

Vascular injury

Splenic laceration

Bladder injury

The blunt trocar takes less force to insert than the bladed trocar.

The blunt trocar should only be placed in the midline.

The blunt trocar requires formal closure of the port site regardless of its size.

The blunt trocar decreases the chance of injury to the epigastric vessels.

The blunt trocar eliminates possible trocar injury to the bowel.