Abstract
Erroneous punctures and insufflations are frequent with the use of the Veress needle. Mistaken injections of gas in the preperitoneal space are not rare. The purpose of this research is to evaluate the correct positioning of the tip of the needle during creation of pneumoperitoneum. The needle was inserted into the peritoneal cavity. Tests to assess the positioning of the needle tip were carried out. Pressure, flow rate and volume were periodically recorded and the needle was removed, being immediately reinserted into the right hypochondrium and placed in the preperitoneal space. The liquid flow test was always positive in the peritoneal cavity. No resistance to saline injection into the peritoneal cavity was observed, but increased resistance to saline injection into the preperitoneal space was observed in 45.5% of the cases. Some saline was recovered in 63.5% of the cases in the peritoneal cavity, and in 54.5% in the preperitoneal space. Saline drop test was positive in 66.6% of the cases in the peritoneal cavity and in 45.5% in the preperitoneal space. In the peritoneal cavity, initial pressure lower than 5 mm Hg was observed, and this pressure gradually increased during 123 seconds until reaching 15 mm Hg. In the preperitoneal space, initial pressure was 15 mm Hg. Aspiration, liquid flow and saline drop tests are important, whereas recovery test is inconclusive. Initial pressure of approximately 5 mm Hg indicates that the tip of the needle is in the peritoneal cavity. The peritoneal cavity should hold ten times as much volume of gas as the preperitoneal space. The increase in pressure and volume in the peritoneal cavity can be predicted by statistics.
Highlights
The establishment of pneumoperitoneum is the most critical procedure in videolaparoscopy[1], and there is no consensus with regard to the best method of gaining access to the peritoneal cavity in such procedure[2]
In the recovery test, nothing was recovered in 63.6% of the cases in which the needle tip was inside the peritoneal cavity
The same occurred in 54.5% of the cases in which the needle tip was inside the preperitoneum
Summary
The establishment of pneumoperitoneum is the most critical procedure in videolaparoscopy[1], and there is no consensus with regard to the best method of gaining access to the peritoneal cavity in such procedure[2]. Several subjective tests are taught in textbooks[15,16,17] to ascertain the positioning of the tip of the needle inside the peritoneal cavity before insufflations, such as liquid flow, aspiration, saline drop, injection and recovery tests. Gas volume and gas flow rate during insufflations are objective parameters, which may be related to the actual location of the needle at any given moment during the procedure. Such relations have not yet been established, in spite of being of great value in order to guide the surgeon through the crucial moment of the creation of a pneumoperitoneum. The objectives of this research are: 1. To evaluate the accuracy of the tests currently taught to confirm the correct positioning of the Veress needle in the peritoneal cavity
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