Creating the Pneumoperitoneum

  • Levent AvtanEmail author


This chapter focuses on starting the pneumoperitoneum and is a guide to prevention and management of access and exposure-related risk factors and complications; it also deals with pneumoperitoneum-associated alterations and complications. Main subtitles of this chapter are as below:
  • Access to Peritoneal Cavity and Exposure
    • Noninsufflated entry method
      • Trocar placement without prior pneumoperitoneum

      • Open method

    • Pre-insufflated entry method with Veress needle
      • Visual entry method (with or without pre-insufflation)

  • Access and Exposure-Related Risk Factors
    • Improper placement of Veress needle

    • Sudden uncontrolled entry into the peritoneal cavity

    • High-pressure reading

    • Poor visualisation

    • Risks related with port location

    • Uncontrolled entry

    • Removal of cannulas (Video 1.1)

  • Access and Exposure-Related Complications
    • Preperitoneal insufflation (Video 1.2)

    • Piercing the greater omentum with Veress needle

    • Puncture of a hollow organ with Veress needle

    • Complications of Potential Space Exposure

  • Complications of Trocar Placement
    • Abdominal wall haemorrhage

    • Major vascular injury

    • Bowel injury

    • Bladder injury

    • Trauma related with the type of port (Video 1.3)

  • Pneumoperitoneum-Associated Complications
    • Cardiopulmonary trouble

    • Gas embolisation

    • Deep vein thrombosis

    • Postoperative shoulder or subphrenic pain

  • Pneumoperitoneum-Associated Physiologic Alterations
    • Mechanical effects of increased intra-abdominal pressure

    • Direct systemic effects of absorbed CO2

  • Pneumoperitoneum and Abdominal Sepsis


Veress Needle Peptic Ulcer Perforation Trocar Placement Carbon Dioxide Insufflation Major Vascular Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Video 1.1

Trocar site bleeding 90 s (MP4 106182 kb)

Video 1.2

Preperitoneal insufflation 54 s (MP4 61313 kb)

334927_1_En_1_MOESM3_ESM.mp4 (98.9 mb)
Video 1.3 Injury risk related with the type of port 60 s (thanks to Prof. Selman Uranüs for this video) (MP4 101247 kb)


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Istanbul School of Medicineİstanbul University Continuing Medical Education and Research Centre, Turkish National Association for Endoscopic Laparoscopic SurgeryIstanbulTurkey

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