The difficulty in creating the pneumoperitoneum may be overcome by introducing the Veress'' needle through the posterior vaginal fornix. Local skin infections may require that the locations for the abdominal incisions be altered. Generalized peritonitis Intestinal obstruction or ileus. This is a relative contra-indication because of the increased risk of bowel perforation upon entry of the Veress'' needle or trocars. Coincidental medical conditions such as ischemic heart disease, blood dyscrasias or coagulopathies.
Ancillary instruments Forceps A wide range of forceps are available for laparoscopic use.
It is less important to have a wide range of forceps than to have perfected the use of one or two. It is important to have at least one of each, an atraumatic forceps and a forceps with teeth for stronger traction. Scissors Scissors which pass through a 5 mm port are sufficient for general dissection. Microscissors may be preferable for adhesiolysis close to the fimbriae or in other delicate locations. It is important that one of the blades is fixed to allow gentle traction to be applied before cutting.