Secondary 8-12 mm, rather than 5 mm trocars, may be useful for some procedures. The pressure of the pneumoperitoneum and the extent of the Trendelenburg position must be adapted to the hemodynamic and respiratory demands of each individual patient. Continued communication and collaboration with the anesthetist throughout the procedure is mandatory. This is extremely important because it may be necessary to reduce the Trendelenburg position, lower the intraabdominal pressure, or even convert to laparotomy at any time during the procedure. Inspection of the abdomen and pelvis It is important to approach the evaluation of the pelvis in a systematic and thorough manner.
Upper abdomen Begin the inspection with the upper abdomen.
Rotate the laparoscope to view the caecum and appendix, using a probe if necessary. Examine the course of the ascending colon to the hepatic flexure. Examine the right lobe of the liver and gall bladder. Avoiding the ligamentum falciparum, the laparoscope is rotated to view the left lobe of the liver and stomach. And finally, rotate the laparoscope around to view the descending colon.