- Stop surgery and deflate the pneumoperitoneum.
- Continue supportive treatment, hyperventilation, and positive end-expiratory pressure.
- Confirm the diagnosis of pneumothorax by clinical examination, if time permits, chest ultrasound and/or x-ray.
- Treat according to the severity of cardiopulmonary compromise.
- Minimal compromise—treat with observation
- Moderate to severe compromise—place intercostal cannula or temporary drain
- Recannulation of capnothorax—place chest drain
- After stabilization, resume procedure with lower (10 mm Hg) intra-abdominal pressures
- If capnothorax reoccurs, it may be necessary to convert to an open procedure
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