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The abdomen is distended with carbon dioxide gas (see diagram 3) to create a space for surgical procedures and better visualization of organs. An abdomen inflated with gas is termed a pneumoperitoneum. Carbon dioxide gas is infused under pressure through the primary trocar site; usually 2 to 3 L is adequate. The pressure inside the abdomen should not exceed 20mmHg. The trocar sites can be kept sealed with valves to maintain the pneumoperitoneum (so air does not leak out). However, valves can interfere with frequent insertion and removal of surgical instruments, so they are not preferred in the secondary trocar sites. Thus, a high flow insufflator that administers up to 10 L of gas per minute is necessary to maintain the pneumoperitoneum.
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