Modified Veress Needle Research Articles

A modified open technique using the Veress needle through facial defect for port insertion in pediatric laparoscopy

Laparoscopic procedures are being performed in infants and children much more frequently. Nevertheless, there is anxiety about complications resulting from port insertion due to the smaller abdominal cavity in children. Most complications are related to the entry of the first port. In this study, we present our patients who underwent laparoscopy using our modified Veress needle technique. The hospital records of the patients who underwent laparoscopy between 2010 and 2015 were evaluated retrospectively regarding intraoperative and postoperative complications. In all patients, the first port was inserted using our modified Veress needle technique. Laparoscopic procedures were performed on 139 patients. There were no major intraoperative or postoperative complications such as visceral or vascular injury in our patients. Only 5 (3.5%) minor complications were determined intraoperatively. Minor intraoperative complications included port dislocation (n = 2), intra-abdominal gas leakage (n = 1), subcutaneous emphysema (n = 1), and abdominal wall bleeding (n = 1). There were no minor complications postoperatively. In our technique, the umbilicus is pulled upwards strongly, reducing the risk of intra-abdominal injury.

Re: The modified Veress needle for tension pneumothorax

Re: The modified Veress needle for tension pneumothorax

Relative device stability of anterior versus axillary needle decompression for tension pneumothorax during casualty movement: Preliminary analysis of a human cadaver model.

Tension pneumothorax (tPTX) remains a significant cause of potentially preventable death in military and civilian settings. The current prehospital standard of care for tPTX is immediate decompression with a 14-gauge 8-cm angiocatheter; however, failure rates may be as high as 17% to 60%. Alternative devices, such as 10-gauge angiocatheter, modified Veress needle, and laparoscopic trocar, have shown to be potentially more effective in animal models; however, little is known about the relative insertional safety or mechanical stability during casualty movement. Seven soft-embalmed cadavers were intubated and mechanically ventilated. Chest wall thickness was measured at the second intercostal space at the midclavicular line (2MCL) and the fifth intercostal space along the anterior axillary line (5AAL). CO2 insufflation created a PTX, and needle decompression was then performed with a randomized device. Insertional depth was measured between hub and skin before and after simulated casualty transport. Thoracoscopy was used to evaluate for intrapleural placement and/or injury during insertion and after movement. Cadaver demographics, device displacement, device dislodgment, and injuries were recorded. Three decompressions were performed at each site (2MCL/5AAL), totaling 12 events per cadaver. Eighty-four decompressions were performed. Average cadaver age was 59 years, and body mass index was 24 kg/m. The CWT varied between cadavers because of subcutaneous emphysema, but the average was 39 mm at the 2MCL and 31 mm at the 5AAL. Following movement, the 2MCL site was more likely to become dislodged than the 5AAL (67% vs. 17%, p = 0.001). Median displacement also differed between 2MCL and 5AAL (23 vs. 2 mm, p = 0.001). No significant differences were noted in dislodgement or displacement between devices. Five minor lung injuries were noted at the 5AAL position. Preliminary results from this human cadaver study suggest the 5AAL position is a more stable and reliable location for thoracic decompression of tPTX during combat casualty transport. Therapeutic study, level III.

Various Port-site Closure Techniques in Laparoscopic Surgeries

Introduction: Minimally invasive surgeries are the advantageous and cosmetically better surgical procedures nowadays. But laparoscopic trocars do create wounds. It is necessary to close these wounds with a good technique in order to decrease the complications related to port-site complications, especially hernia. Aim: This study is to review and list different techniques used for closure of port-site wounds. Materials and methods: A literature search was performed for the articles related with techniques of closure of trocar sites. For this purpose, the search engines used were Google, HighWire Press, and SpringerLink. Only those techniques that include the usage of suture materials, suture carriers, and various needles were reviewed in this study. Special devices made for port-closure are not reviewed here. Results: The study describes many techniques, including classical closure using curved needles, such as the Grice needle, Maciol needles, spinal needles, dual hemostat, suture carrier, modified Veress needle with a slit made in retractable brunt tip, dental awl with an eye, prolene 2/0 on straight needle aided by Veress needle, straight needle armed with suture, modified Veress needle bearing a crochet hook at tip; Foley catheter threaded through port-hole for elevation of fascial edge upon traction; fish-hook needle improvised out of a hypodermic needle by bending it to 180°; U-shaped purse-string suture placed in the fascia around port-hole. Conclusion: There are plenty of techniques for closure of trocar-site wounds, all of them are effective in closing the fascial defect of abdominal wall.

Modified Veress needle decompression of tension pneumothorax

The current prehospital standard of care using a large bore intravenous catheter for tension pneumothorax (tPTX) decompression is associated with a high failure rate. We developed a modified Veress needle (mVN) for this condition. The purpose of this study was to evaluate the effectiveness and safety of the mVN as compared with a 14-gauge needle thoracostomy (NT) in a swine tPTX model. tPTX was created in 16 adult swine via thoracic CO2 insufflation to 15 mm Hg. After tension physiology was achieved, defined as a 50% reduction of cardiac output, the swine were randomized to undergo either mVN or NT decompression. Failure to restore 80% baseline systolic blood pressure within 5 minutes resulted in crossover to the alternate device. The success rate of each device, death, and need for crossover were analyzed using χ. Forty-three tension events were created in 16 swine (24 mVN, 19 NT) at 15 mm Hg of intrathoracic pressure with a mean CO2 volume of 3.8 L. tPTX resulted in a 48% decline of systolic blood pressure from baseline and 73% decline of cardiac output, and 42% had equalization of central venous pressure with pulmonary capillary wedge pressure. All tension events randomized to mVN were successfully rescued within a mean (SD) of 70 (86) seconds. NT resulted in four successful decompressions (21%) within a mean (SD) of 157 (96) seconds. Four swine (21%) died within 5 minutes of NT decompression. The persistent tension events where the swine survived past 5 minutes (11 of 19 NTs) underwent crossover mVN decompression, yielding 100% rescue. Neither the mVN nor the NT was associated with inadvertent injuries to the viscera. Thoracic insufflation produced a reliable and highly reproducible model of tPTX. The mVN is vastly superior to NT for effective and safe tPTX decompression and physiologic recovery. Further research should be invested in the mVN for device refinement and replacement of NT in the field.

Different Port Closure Techniques in Laparoscopy Surgery

Introduction: Any new surgical procedure, face a new technical challenges, although minimally invasive surgery cause evident reduction of the pain to the patient postoperatively, with better cosmesis, but with time, new challenges appears. One of challenges is port closure techniques, in order to prevent the trocar site hernias and other complications . Aims: The aim of this study to review and list different techniques used for closure of the trocar sites. Methods: A literature search was performed for articles and text books dealing with techniques of closure. The author searched this subject using Medline and the search engine Google, Springerlink and High wire Press. The following search term were used; port site closure techniques. Review, All articles reporting techniques with their references were reviewed with some text books. Results: in this literature review we described many techniques in addition to classical closure using curved needles, including Grice needle, Maciol-needles, endoclose device. Carter-Thomason device, Tahoe ligature device, Endo-Judge device, exit puncture closure device, Owsley retractor, spinal cord needles, dual hemostat, Veress needle loop technique,suture carrier, Riverdin and Deschamps needles, and Gore-Tex closure device. Semm's emergency needle with adistal eyelet; the modified Veress needle with a slit made in the retractable brunt tip; dental awl with aneye; prolene 2/0 on a straight needle aided by a Veress needle; a straight needle armed with suture; Auto stitch (United States Surgical), a modified Veress needle bearing a crochet hook at the tip. Foley catheter threaded through the port hole forthe elevation of fascial edge upon traction; fish-hook needle improvised out of a hypodermic needle by bending it 180°; Grooved director; U-shaped purse-string suture placed in the fascia around the port hole . Conclusion: Although there are different techniques used to close the trocar site, all of them are effective in closing the defect in the fascial layers of the abdominal wall, two main groups of techniques were found.

Development, standardization, and evaluation of NOTES cholecystectomy using a transsigmoid approach in the porcine model: an acute feasibility study

Transluminal cholecystectomy is feasible. However, the procedure is time consuming, difficult, and poorly standardized so far. In the present study we therefore aimed to further evaluate and optimize a transsigmoid approach for cholecystectomy with minimal transabdominal assistance in the porcine model. After a pilot series of 6 pigs, NOTES (natural-orifice transluminal endoscopic surgery) cholecystectomy was performed in a standardized manner in another 12 pigs. A transsigmoid approach was applied via a specially designed trocar (ISSA) with a double-channel gastroscope advanced into the peritoneal cavity. After identification of the infundibulum, the cystic duct and artery were closed by application of hemostasis clips. After dissection of these structures, the gallbladder was separated from the liver by electrocautery following injection of isotonic saline solution. A grasper introduced through a modified Veress needle (initially used for establishing the hydroperitoneum) and an additional transcutaneous stay suture were used to ease preparation of the gallbladder. Transluminal cholecystectomy was successfully performed in all animals. No serious acute complications occurred; minor bleeding in 4 out of 12 cases (1 cystic artery and 3 liver parenchyma) was successfully handled by electrocautery. Clip application to close the cystic duct and artery resulted in complete sealing. Standardization of the procedure was associated with a significant decrease in total operating time (113.3 +/- 31.8 minutes for the first 6 pigs and 73.6 +/- 17.2 minutes for the last 6 pigs). In pigs with a healthy gallbladder, our standardized technique of transsigmoid cholecystectomy could be performed relatively fast with acceptable complication rates at this level of evolution, as shown in these acute experiments.

Culdoscopy using an optical cannula

Objective: To describe a technique for inserting an endoscope through the posterior vaginal fornix under direct vision using an optical cannula. Design: Prospective case study. Setting: University Department of Obstetrics & Gynecology. Patient(s): Patients with infertility referred for investigation in secondary care. Intervention(s): Insertion of culdoscope using an optical cannula. Main Outcome Measure(s): Successful introduction of the culdoscope. Result(s): Sixteen of 20 patients had successful introduction of the optical cannula. There were no reported complications. Conclusion(s): Insertion of a culdoscope into the cul-de-sac can be done under visual control and this may reduce the risks of complications associated with blind insertion using a modified Veress needle.

A method of closing laparoscopy port incisions using a modified Veress needle

A new method of closing laparoscopy port incisions uses a modified Veress needle. The device easily closes the fascia and peritoneum, which should prevent incisional hernias at these sites. It adds little if any cost to laparoscopic procedures. It has been used in 28 patients with satisfatory results.

Extracorporeal suturing of trocar-induced defects and vascular injuries in the abdominal wall during laparoscopy using a modified Veress needle

Anterior wall bleeding and incisional hernias are two frequent complications of laparoscopic surgery. The inside of the retractable blunt tip of a Veress needle modified by a slit (0.5 mm wide x 0.5 mm deep) functions as a ligature carrier. Extracorporeal ligation of vessels or closure of fascial or peritoneal defects is achieved easily and rapidly by this technique.

Mini-laparoscopy: Early experience and findings

SummaryUsing a novel mini-laparoscope, 1.8 mm in diameter, passed through a modified Veress needle we have prospectively evaluated 12 patients undergoing subsequent formal laparoscopy. Following routine insufflation, the Veress needle is removed leaving a 3 mm plastic sheath through which the mini-laparoscope is introduced. Without the aid of further ports a record was made of structures identified. The structures successfully identified were as follows: liver, 12; gall bladder, 7; stomach, 12; small bowel, 12; large bowel, 11; appendix, 5; ovaries, 3 (or six females); and inguinal anatomy, 11. Although this procedure can easily be performed under local anaesthesia the short focal length of the optics restricts the visual field. For high diagnostic accuracy to be achieved, extra manipulating instruments would be required to allow satisfactory abdominal examination. Further experience of this system is now being obtained at laparoscopy for abdominal emergencies.