16. Access to the abdominal cavity

Laparoscopic surgery, by definition, implies working inside a virtual natural cavity, which becomes real after the creation of a pneumoperitoneum. There are three technical approaches: The surgeon should know the technical details, advantages, and potential complications of each method. There are several situations in which the surgeon should be aware of the increased difficulty of establish the pneumoperitoneum, such as, pregnancy, liver cirrhosis, and hostile abdomen (previous surgery). There is a lack of evidence on this topic. What has been proven is the advantage of direct optical trocar entry over the Veress needle technique, with a higher initial successful entry with the optical trocar.