Veress needle insertion in the left hypochondrium in creation of the pneumoperitoneum

PURPOSE: To test the efficacy of the puncture in the left hypochondrium as an alternative method. METHODS: Sixty-two patients randomly distributed into two groups were studied: Group LH, puncture in the left hypochondrium (n=30), and Group ML, puncture in the abdominal midline (n=32). The following were assessed: needle positioning tests, number of failed attempts at needle insertion, and time needed for creation of pneumoperitoneum. Gas flow, volume and intraperitoneal pressure were recorded at every 20 seconds, until a 12 mmHg pressure was reached inside the peritoneal cavity. RESULTS: A similar number of positive results for the needle positioning tests were observed in both groups. Two failed attempts to reach the peritoneal cavity were observed in Group ML and one in Group LH. The time necessary for the creation of pneumoperitoneum was on average 3 minutes and 46 seconds for Group LH, and 4 minutes and 2 seconds for Group ML. Average gas flow, volume and pressure were equivalent for both groups. CONCLUSION: Puncture in the left hypochondrium was as effective as puncture in the abdominal midline for the creation of pneumoperitoneum.

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Classical Closed Technique by Veress Needle Insertion Versus Direct Trocar Insertion in the Creation of Pneumoperitoneum in Various Laparoscopic Surgeries

International Journal of Contemporary Medical Research [IJCMR] ◽

10.21276/ijcmr.2019.6.7.34 ◽

2019 ◽

Vol 6 (7) ◽

Cited By ~ 1

Author(s):

Umer Mushtaq ◽

Ghulam Mohammad Naikoo ◽

Ishfaq Ahmad Gilkar ◽

Javid Ahmad Peer ◽

Waseem Ahmad Dar ◽

...

Keyword(s):

Needle Insertion ◽

Veress Needle ◽

Trocar Insertion ◽

Closed Technique ◽

Direct Trocar Insertion ◽

The Creation

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Evaluation of tests performed to confirm the position of the Veress needle for creation of pneumoperitoneum in selected patients: a prospective clinical trial

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502006000600006 ◽

2006 ◽

Vol 21 (6) ◽

pp. 385-391 ◽

Cited By ~ 18

Author(s):

Otávio Cansanção de Azevedo ◽

João Luiz Moreira Coutinho Azevedo ◽

Albino Augusto Sorbello ◽

Gustavo Peixoto Soares Miguel ◽

Jorge Luis Wilson Junior ◽

...

Keyword(s):

Predictive Value ◽

Iatrogenic Injury ◽

Veress Needle ◽

False Negatives ◽

Injection Test ◽

Intraperitoneal Pressure ◽

Left Hypochondrium ◽

Liquid Injection ◽

Pressure Test ◽

Drop Tests

PURPOSE: To evaluate tests performed to confirm the position of the Veress needle inserted into the left hypochondrium for creation of pneumoperitonium. METHODS: One hundred patients were submitted to laparoscopic procedure with left hypochondrium puncturing. Needle positioning tests were evaluated. The aspiration test was considered positive when organic material was aspirated; the injection test was considered positive when no increased resistance to liquid injection was observed; the recovery test was considered positive when the liquid injected was not recovered; the saline drop test was considered positive when drops of saline in the syringe disappeared quickly; the initial intraperitoneal pressure test was considered positive when pressure levels were £ 8 mmHg. A positive aspiration test indicated iatrogenic injury, whereas a positive result in any of the other tests indicated that the tip of the needle was correctly positioned in the peritoneal cavity. Sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of the tests were calculated by correlating results considered true positives (a), false positives (b), false negatives (c) and true negatives (d), according to the formulas: SE = [a/(a + c)] x 100; SP = [d/(b + d)] x 100; PPV = [a/(a + b)] x 100; NPV = [d(c + d)] x 100. RESULTS: With regard to the aspiration test, SE and PPV were not applicable, SP was 100% and NPV was 100%. With regard to the injection test, SE was 0%, SP was 100%, PPV was inexistent and NPV was 90%. Both recovery and saline drop tests yielded the following results: SE was 50%, SP was 100%, PPV was 100% and NPV was 94.7%. The initial intraperitoneal pressure test yielded the following results: SE, SP, PPV and NPV were 100%. CONCLUSIONS: When inserting the Veress needle into the left hypochondrium, a negative aspiration test guarantees the absence of iatrogenic injury; the injection test is not reliable to determine incorrect needle positioning, but it accurately detects correct needle positioning; recovery and saline drop tests are not reliable to determine correct needle positioning, but they accurately detect incorrect needle positioning; the initial intraperitoneal pressure test is reliable to determine both correct and incorrect needle positioning, and proved to be the most reliable of the tests analyzed.

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Latif’s point: A new point for Veress needle insertion for pneumoperitoneum in difficult laparoscopy

Asian Journal of Endoscopic Surgery ◽

10.1111/ases.12418 ◽

2017 ◽

Vol 11 (2) ◽

pp. 133-137

Author(s):

Mohamed E Abd Ellatif ◽

Wagih M Ghnnam ◽

Ashraf Abbas ◽

Magdy Basheer ◽

Ibrahim Dawoud ◽

...

Keyword(s):

Needle Insertion ◽

Veress Needle

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Comparison of Complications between Direct Trocar Insertion Versus Veress Needle for Creation of Pneumoperitoneum in Patients Undergoing laparoscopic Cholecystectomy: A Randomized Control Trial

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i40a32247 ◽

2021 ◽

pp. 294-299

Author(s):

Kamran Hamid ◽

Shabbir Ahmad ◽

Bahzad Akram Khan ◽

Muhammad Faheem Answer ◽

Amer Latif ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Needle Insertion ◽

Veress Needle ◽

P Value ◽

Surgical Department ◽

Trocar Insertion ◽

Laparoscopic Entry ◽

Significant Difference ◽

Duration Of Surgery ◽

Direct Trocar Insertion

Aim: To compare the outcomes in term of complication of Veress Needle Insertion (VNI) to Direct Trocar Insertion (DTI) for creation of pneumoperitoneum in laparoscopic cholecystectomy. Design: Randomized controlled trial Place and Duration of Study: The current analysis was conducted at Khawaja Muhammad Safdar Medical College Surgical Department, Allama Iqbal Memorial Hospital and Govt. Sardar Begum Teaching Hospital, Sialkot from September 27, 2017, to September 26, 2020. Methodology: A total of six hundred and eight (n=608) patients, having age 30 to 75 years planned for laparoscopic cholecystectomy were included in this study. Patients were randomly divided into two groups, Group A (Direct Trocar Insertion), Group B (Veress Needle Insertion). Both groups had age and sex matched males and female. All trocars and veress needle used were disposable, with a safety shield. The primary outcome of our study was to compare the complications to assess the safety levels, while total time taken by the procedure and mean time for laparoscopic entry were the secondary end points. The collected data was analyzed by using software SPSS version 22. Chi-square test was used to check the significance of variance. P-value less than 0.05 remained the statistically significant. Results: The complication rate in VNI group were significantly greater than the DTI group (p < 0.01), the duration of surgery between the two groups was not significantly different (p > 0.05), but we found statistically significant difference in mean laparoscope insertion time (DTI 3.4+ 1.4 versus VNI 4.8+ 0.7 minutes, p < 0.001). Conclusion: From the results of our study, it can be concluded that the direct trocar insertion is a safe alternative to veress needle insertion in laparoscopic cholecystectomy as it is associated with fewer complications.

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