Direct laparoscopy without prior pneumoperitoneum

It has been assumed that pneumoperitoneum is a requirement prior to insertion of the laparoscope trocar and sleeve. The results of direct trocar insertion without prior establishment of pneumoperitoneum were documented in 1,108 consecutive laparoscopies. No technical failures or operative complications attributable to the method were encountered. In sterilization procedures using the Falope Ring, less than 1L of carbon dioxide was used, resulting in less post-operative abdominal and shoulder pain. Subcutaneous hemorrhage was significant, although all the symptoms disappeared without treatment. Use of this method with obese patients created no major problem.