Layers which are penetrated with trochar & cannula in production of pneumoperitoneum are
.CO2 is commonly used to create pneumoperitoneum as-* It is readily available * It is cheaper * It suppresses the combustion * It is easily absorbed by tissues * It has a high diffusion coefficient * It is quickly released respiration Other gases used are: Air, nitrous oxide, helium, argon.Pneumoperitoneum is created up to a pressure of 15 mmHg which distends the abdominal cavity adequately to have proper visualisation of the abdominal contents. Laparoscope is inseed through the umbilical po (10 mm). Abdomen is evaluated for any pathology. Liver, gallbladder, pelvic organs are visualised. Additional pos (3-4) through trocars are placed depending on the procedure to be done. It may be eitherm5 mm po or 10 mm po. These pos are placed in such a way to have a proper triangulation of instruments for dissection.To use clip applicator 10 mm po is required.Pneumoperitoneum is created using veress needle through umbilical incision. Access can be achieved by open method through an umbilical incision. ref:SRB&;S manual of surgery,ed 3,pg no 1140
Skin & superficial fascia
Deep fascia
Rectus abdominis
Transversus abdominis
G.I.T