A 28 year-old obese woman was scheduled for robot-assisted bilateral tubal re-anastomosis under general
anesthesia and neuromuscular blockade. As part of a respiratory mechanics study, gastric pressure (Pga) was measured. At
the beginning of the operation, the surgeon repeatedly inserted a Veress needle consistently measuring an unusually high
opening pressure of 15 mmHg, at a time when Pga was 12.5 mmHg. Based on the elevated Pga values, we inferred that
the high opening pressure was a valid intra-peritoneal pressure, rather than a sign of incorrect needle placement; therefore,
the surgeon proceeded with uneventful insufflation of the peritoneal cavity. This patient exhibited an unusually high
opening intra-abdominal pressure that likely reflected her high degree of central obesity. Simultaneous Pga determination
proved valuable in confirming intra-peritoneal location of the tip of Veress needle and may be a viable method of
corroborating high opening pressures despite safe needle positions in laparoscopic cases.
Latif’s point: A new point for Veress needle insertion for pneumoperitoneum in difficult laparoscopy