title: Cul-de-sac insufflation: an easy alternative route for safely inducing pneumoperitoneum.
abstract: Since 1977, routine cul-de-sac insufflation to achieve a pneumoperitoneum for laparoscopy was performed on 350 women under local anesthesia. A van Schie/van Lith intrauterine tenaculum, used together with a self-retaining Trelat speculum, guaranteed maximum stretching of the posterior vaginal fault and fixation of the anteflexed uterus necessary for an accurate 1-cm deep penetration of a pneumoperitoneum needle into the cul-de-sac. The correct position of the tip of the needle was determined precisely by means of two manometers. The failure rate in the first study of 195 procedures was 3.6% and that in the following 155 cases was 1.9%. There were no serious operative complications. The authors recommended the cul-de-sac insufflation approach for inducing pneumoperitoneum as the technique of choice.
mesh_terms: D004312:Douglas' Pouch; D005260:Female; D006176:Gynecology / Q000295:instrumentation; D006801:Humans; D010535:Laparoscopy; D009339:Needles; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D011247:Pregnancy; D011677:Punctures; D013246:Sterilization, Tubal; D014621:Vagina