The umbilical camera port is placed first by Verres or Hasson technique. Exposure of the lower midline fascia below the base of the umbilical stalk for the Hasson technique is shown. Controlled penetration of the exposed peritoneum is accomplished with a blunt (Pean) clamp. Initial insufflation through the large Hasson cannula is done with slow (2L/min) flow so that the inferior vena caval return is not suddenly reduced (flow through the small Veress needle is self-limiting). The flow is later increased to 6L. Maximal patient pressure should be 11mm Hg for a thin individual up to 15mm for an obese patient. The patient is placed in reverse Trendellenberg position and initial visual exploration is done checking for penetration injury and anatomic impediments (eg. adhesions).
A 10/11mm epigastric port is placed level with the position of the gallbladder. Any higher and there might be interference from the edge of the left hepatic lobe. The trochar point is engaged in the midline fascia and then directed to the right to penetrate at the junction of falciform ligament and abdominal wall.
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