Major proceduresFree in the app
Diagnostic laparoscopy & safe entry
Pain, endometriosis, subfertility (dye test), ectopic, adnexal mass.
Source: RCOG GTG 49 · BSGESteps
- Flat (no head-down) for entry; empty bladder; uterine manipulator.
- Veress at umbilicus: lift abdominal wall; 45° if slim, up to 90° if obese; no side-to-side movement.
- Confirm entry: opening pressure <8–10 mmHg with free flow.
- Insufflate to 20–25 mmHg for primary trocar entry.
- Insert scope; check directly beneath entry site.
- Secondary ports under vision, lateral to inferior epigastric vessels.
- Reduce to 12–15 mmHg for operating.
- End: deflate fully; remove ports under vision; close fascia of ports ≥10 mm.
Alternative entry
| Palmer’s point | 3 cm below left costal margin, midclavicular line — periumbilical adhesions, hernia, failed umbilical entry. Empty stomach first. |
|---|---|
| Hasson (open) | Previous midline laparotomy, very thin or very obese, or 2 failed Veress attempts. |
Consent risks
| Serious injury | ~2 per 1000 (bowel, bladder, uterus, vessels) |
|---|---|
| Death | 3–8 per 100,000 |
| Port hernia | <1 per 100 |
A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.