If one does not obtain a free flow or an unobstructed saline irrigation, then the Veress needle may be removed and reinserted. In general it is safer to convert the umbilical site into the Hasson open approach (Plate 91) if any difficulty is experienced with the placement, irrigation, or insufflation of the Veress needle. The appropriate tubing and cables for the CO2 insufflation, the fiberoptic light source, and the laparoscopic videoscope with its sterile sheath are positioned as are the lines for the cautery or laser, suction, and saline irrigation. The pneumoperitoneum begins with a low flow of about 1 or 2 L/min with a low-pressure limit of approximately 5 to 7 cmH2O. Once 1 to 2 L of CO2 are in, the abdomen should be hyperresonant to percussion. The flow rate may be increased; however, the pressure should be limited to 15 cmH2O. Three to four liters of CO2 are required to fully inflate the abdomen and the Veress needle is removed. After grasping either side of the umbilicus, a 10-mm trocar port is inserted with a twisting motion, aiming towards the pelvis (Figure 6). If a disposable trocar port is used, it is important to be certain that the safety sheath is cocked. A characteristic popping sensation is felt as the trocar enters the peritoneal space. The trocar is removed and the escape of free CO2 gas is verified.