ABSTRACT
To a greater extent than in pneumoperitoneum laparoscopy, lift (gasless)- laparoscopy becomes difficult when severe adhesions are present around the periumbilical area. If adhesions are found in the lower abdominal quadrant, the retractor can be inserted first in the direction of the upper abdominal cavity or in a direction where no adhesions are present. After inspecting the abdominal cavity with the endoscope, an area free from adhesions must be located where a trocar can be introduced enabling an initial adhesiolysis to be performed. Sometimes a low-pressure (8-10 mmHg) pneumoperitoneum is necessary to perform adhesiolysis, prior to insertion of the abdominal wall retractor.
