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Dr.’s Matsuzaki and Botchorishvili raise a great point and rightly seek to add further light on a potential contributory mechanism of gas leak through trocars during laparoscopyit would be lovely to see some of their clinical data in this regard accrued during trials regarding low pressure pneumoperitoneum. We’d be delighted to collaborate in any way with them and others in this area. We are ourselves specifically evaluating the pneumoperitoneum pressure effect on trocar valve apposition after instrumentation with work (both mechanical and computational modelling) ongoing to understand the relative importance of ‘use fatigue’ versus insufficiency of ‘gas pressure reseal’. In counterbalance, while passive leaks may be more likely and more prolonged with lower pneumoperitoneal pressures, higher pressures induce leaks of greater velocity and turbulence at the moment of instrument withdrawal and indeed insertion too (see Fig. 1). The latter so may be more relevant re particle dispersal trajectory (rather than gas leak volume) in considerations regarding surgical team pathogen/ pollutant (e.g., surgical smoke constituents) hazard. While lower pressure is also likely beneficial re leakage occurring at the level of the abdominal wall although, these leaks tend to contour the

Author response to: solving the problems of gas leakage at laparoscopy