Veress needle injury in laparoscopy: A catastrophic complication

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.

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COMPARISON OF A NEW VERESS NEEDLE ENTRY METHOD AND CLASSIC VERESS NEEDLE ENTRY METHOD IN GYNECOLOGIC LAPAROSCOPY: A PROSPECTIVE RANDOMIZED STUDY

International Journal of Research -GRANTHAALAYAH ◽

10.29121/granthaalayah.v6.i2.2018.1546 ◽

2018 ◽

Vol 6 (2) ◽

pp. 74-79

Author(s):

Uğurkan Erkayıran ◽

Bülent Köstü ◽

Alev Özer

Keyword(s):

Horizontal Plane ◽

Randomized Study ◽

Veress Needle ◽

Operative Outcomes ◽

Laparoscopic Entry ◽

Gynecologic Laparoscopy ◽

The Mean ◽

Group 2 ◽

Needle Entry ◽

Group 1

Background: To compare cranial 15º angulation of Veres needle to classic Veress needle entry in closed laparoscopic entry in obese patients. Method: Patients with BMI index>30 were divided into two groups. Initial entry into the abdomen in Group 1 (n=29) was performed with the intraumbilical insertion of Veress needle in 90o angle relative to the horizontal plane. In Group 2 (n=31) the Veress needle was placed intraumbilically in a cranial direction, the tip of the needle towards the thoracic cavity, with an angle of 15o to the horizontal plane. Two groups were compared with respect of the operative outcomes. Results: In Group 2, the mean number of Veress needle entries attempt was significantly lower than Group 1 (p=0.01). Time to insertion of the Veress needle was found to be significantly shorter in Group 2 than in Group 1 (p<0.001). While entry failure occurred in 3 patients in Group 1 (10.3%), no failures were monitored in any patients in Group 2 (p= 0.01). Complication rate was significantly lower in Group 2 than in Group 1 (p= 0.03). Conclusion: Placement of Veress needle intraumbilically in a cranial direction at 15°angle to the horizontal plane increases entry success and reduces complications.

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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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