Force required for Veress needle entry using digital force gauge during laparoscopy: Pilot study

Abstract

Study Objective: The primary objective is to determine the mean peak force required to penetrate through fascia for entry into the abdominal cavity for establishment of pneumoperitoneum with the Veress needle during laparoscopic surgery. The second objective is to identify if body mass index (BMI), history of abdominal surgeries, or smoking contributed to peak force required to penetrate through the fascia. Design: Prospective observational study with women undergoing laparoscopic surgery with a Veress needle and a digital force gauge attached. Setting: Women undergoing laparoscopic gynecological surgery at Danbury Hospital in Danbury, CT. Patients: Women between 18 and 90 years old who underwent scheduled laparoscopic surgery (n=22). Interventions: A digital force gauge was attached to the handle of a Veress needle. The Veress needle was inserted into the abdomen by a gynecologist using standard techniques consistent with evidence-based recommendations. The digital force gauge continuously recorded the force required to penetrate the abdominal layers during the process of gaining abdominal entry. Measurements: Graphical and numerical data obtained from the force gauge device during Veress needle penetration. Main Results: The mean peak force required to gain entry to the abdominal cavity was 1007 gram-force (gF) (n=22, SD=298). Force data varied widely within samples with a range of 1083 gF (min=409, max=1493). There were no significant differences in the peak force among groups 4 stratified by age, (p = 0.327), BMI (p = 0.650), number of previous abdominal surgeries (p = 0.142), smoking status (p = 0.287), and laparoscopic entry location (0.870). Conclusions: This study highlights the variability in insertional force to gain access to the abdomen during operative laparoscopy. These results led to the initiation of an objective method for teaching safe laparoscopic entry using a Veress needle in a simulation lab for the department of Obstetrics and Gynecology.