Makeshift Valve For Laparoscopy

The cannula for insertion of a laparoscope or an accessory instrument has a rubber valve at the outer end. It fits like a cap on it, and has a central hole. The diameter of the hole is a little less than that of the instrument. So when the instrument is passed in through that hole, its edges grip the instrument quite firmly and carbon dioxide used for making the pneumoperitoneum does not leak out. With wear and tear, the hole may become a bit larger. Sometimes a cannula with an inappropriate size is used by mistake. Then the gas leaks out if the instrument is smaller than the cannula. I was called from the adjacent operation theater that day for this problem. The gas was leaking out through the second port. One option was to remove the port and insert a cannula of appropriate size. Unfortunately the instrument was the thinnest of the accessories, and the cannula was also the thinnest of all cannulas available. They wanted to drill the ovaries for polycystic ovarian disease, but could not because there was no pneumoperitoneum. Then I had an idea. I took a sterile surgical glove, placed it palm above the hole in the valve, and pierced it with the drilling needle. The needle went into the peritoneal cavity, with the two layers of the glove hugging it tightly. I wrapped the glove around the cannula. Now the gas remained inside the peritoneal cavity. This was a reducer of sorts. The surgical team was quite happy because they could operate and probably also because they could use this trick the next time they encountered this problem.