Coping with extraperitoneal insufflation during laparoscopy: a new technique.

For most laparoscopists, pneumoperitoneum is essential before introducing a trocar into the peritoneal cavity. Extraperitoneal insufflation is one of the most common complications of laparoscopy; it is difficult to correct and may result in abandonment of the procedure. A technique for dealing with extraperitoneal insufflation is described. We have used this technique successfully on 11 consecutive patients. The gynecologist uses the view created by the extraperitoneal gas to place the Veress needle correctly into the peritoneal cavity. Insufflation proceeds under direct vision; the peritoneum will rise and obliterate the extraperitoneal space. This technique may be useful particularly when alternative methods are contraindicated.