Cul‐de‐sac Insufflation: An Easy Alternative Route for Safely Inducing Pneumoperitoneum

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 recommend the cul‐de‐sac insufflation approach for inducing pneumoperitoneum as the technique of choice.