ABSTRACT
Surgical Technique Critical in the procedure of laparoscopic adhesiolysis are the insertion of the insufflation needle, placement of the trocar, and the adhesiolysis itself.
Pneumoperitoneum In patients who had previous abdominal surgery, the choice of the site and technique of initial access to the peritoneal cavity is very important. The traditional technique is transumbilical, blind insertion of the Veress needle. Such an approach causes bowel perforations in 0.04% and major bleeding in 0.04% of patients, whereas the open laparoscopy technique of surgically entering the peritoneal cavity through the umbilical site is rarely associated with vascular injuries but does not guard against bowel injuries (0.11%) (32). Elevation of the abdominal wall prior to needle introduction increases the distance to the major vessels but does not guard against injury of the bowel adherent to the abdominal wall (33).
