Occasionally, with tense ascites, prolonged leakage of ascitic fluid occurs through the needle site. Absolute contraindications include a coagulation or bleeding disorder, poor patient cooperation, peritonitis, intestinal obstruction, and infection of the abdominal wall. Relative contraindications include severe cardiac or pulmonary disease, large abdominal hernias, multiple abdominal operations, and tense ascites. Laparoscopy is performed with sterile technique in a well-equipped endoscopy suite or operating room. A 5-mm surgical incision is made, and the Verres pneumoperitoneum needle is inserted.
Nitrous oxide is infused into the abdominal cavity.
The incision is extended by 10 to 15 mm, and the cannula with trocar is introduced into the peritoneal cavity. The trocar is removed, and the peritoneoscope is inserted through the cannula. The abdominal contents are examined, and aspiration of ascitic fluid and biopsy procedures are performed as needed. When the procedure is completed, the nitrous oxide is expelled by the patient with a Valsalva maneuver and the cannula is removed. The incision is sutured.