The supraumbilical 10-mm port is placed first, using the open Hasson technique described in Plate 91. After the abdomen is entered and the port secured with the lateral stay sutures, the intraperitoneal space is inflated with carbon dioxide to 15 mm Hg. The surgeon observes the intra-abdominal pressure and total volume of gas infused as the abdomen distends and becomes tympanitic. The videoscope is white-balanced and focused. After the optical end is coated with antifog solution, the scope is advanced into the abdomen under direct vision. All four quadrants of the abdomen are explored visually. Placement of each of the other selected port sites begins with skin infiltration using a local anesthetic. The local needle can then be passed perpendicularly through the abdominal wall and its entry site verified. A 10-mm port is placed in the left midsubcostal position. Five-mm ports are placed in the right lateral subcostal, in the epigastrium just to the right of the midline falciform ligament, and in the far left subcostal positions.