Pneumoperitoneum Needle Research Articles

Short-term efficacy of cholecystectomy plus bile duct T-tube drainage or choledochojejunostomy in the treatment of gallbladder cancer and its effects on median survival time and postoperative complications.

To explore the short-term efficacy of cholecystectomy plus bile duct T-tube drainage or choledochojejunostomy (CJ) in the treatment of gallbladder cancer (GC) and its effects on the median survival time and postoperative complications. The clinical data of 121 patients who underwent laparoscopic cholecystectomy (LC) in department of hepatobiliary surgery of the hospital from January 2018 to December 2018 were retrospectively analyzed. According to the adjuvant treatment methods, the patients were divided into 2 groups: the control group (n = 61, LC + bile duct T-tube drainage) and experimental group (n = 60, LC + CJ). The perioperative indicators, short-term efficacy, median survival time, postoperative complications and immune stress response were compared between the 2 groups of patients before and after propensity score matching. The surgical time, postoperative anal first exhaust time, and intraoperative blood loss in the experimental group were no different from those in the control group (P > .05), but the hospital stay was shorter than that in the control group (P < .05). There was no difference in the effective rate of treatment and median survival time between the 2 groups (P > .05). The total incidence rate of complications in the experimental group at 14 days after surgery was lower than that in the control group (P < .05). Day 3 after surgery, the levels of immunoglobulin M (IgM) and immunoglobulin G (IgG) of the experimental group were higher than those of the control group (P < .05), while the level of C-reactive protein (CRP) was lower than that of the control group (P < .05). Compared with bile duct T-tube drainage, LC + CJ in the treatment of GC can better shorten the postoperative hospital stay and reduce the postoperative complications and immune stress response, but and the median survival time of the 2 is similar, which can be promoted in clinical practice.

Clinical Application of Peritoneal Dialysis Catheterization without Capsular Puncture Technique.

Objective To summarize the advantages of peritoneal dialysis (PD) catheters without capsular puncture (only one pneumoperitoneum needle) puncture technique conducted by our center. Methods The study examines the clinical data of PD patients (including the general situation of patients, intraoperative and postoperative characteristics, and complications) undergoing pneumoperitoneum needle catheterization from January 2019 to May 2021 in the Department of Nephrology at the First Affiliated Hospital of Hebei North University (the largest peritoneal dialysis center in Zhangjiakou). Results A total of 153 surgical cases were collected. There were 91 males and 62 females. The mean (± standard deviation) age was 56.1 ± 18.6 years, and the mean (± standard deviation) follow-up time was 16.7 ± 8.2 months. The average operation time was 30.33 minutes with a standard deviation of 14.80 minutes. The length of abdominal incision is 2.38 ± 0.42 cm, and the blood loss was about 26.3 ± 9.2 ml, including 2 cases of laparoscopic reposition of drift tube, 0 case of pipe blockage, 3 cases of fluid leakage, 1 case of peritoneal dialysis catheter tunnel infection, 4 cases of outlet infection, 12 occurrences of peritonitis, 121.3 patient months in peritonitis, and 0 times in omentum wrapping without bladder injury, incisional hernia, or intestinal injury. Conclusion Relative to open operation, the peritoneal dialysis (PD) catheters with pneumoperitoneum needle puncture technique has the following advantages: simpler operation, shorter operation time, less bleeding, less injury, less complications, and higher safety. Moreover, there are no additional costs compared with open operation. Thus, the technique is recommended for clinical applications.

Inhalation of low-dose desflurane prevents the hemodynamic instability caused by target-controlled infusion of remifentanil and propofol during laparoscopic gynecological surgery: A randomized controlled trial.

The objective of the present study was to determine whether the addition of inhaled desflurane is superior to remifentanil-propofol total intravenous anesthesia (TIVA) alone in patients undergoing laparoscopic gynecological surgery. A total of 60 patients who were scheduled to undergo laparoscopic gynecological surgery were prospectively enrolled and randomly allocated to receive either propofol-remifentanil (PR group; n=30) or combined propofol-remifentanil and low-dose desflurane (PRD group; n=30) for the maintenance of anesthesia. Hemodynamics [mean arterial pressure (MAP); heart rate (HR)], recovery parameters and complications were recorded. The results of the present study indicated that the addition of desflurane significantly reduced the amount of propofol and remifentanil that was administered in the PRD group, compared with that in the PR group. MAP and HR were significantly higher at T3 (5 min post-pneumoperitoneum), but significantly lower at T4 (removal of pneumoperitoneum needle) and T5 (post-operation immediately) in the PR group, compared with the PRD group. Moreover, MAP and HR were significantly altered at multiple time points within the PR group; however, they were relatively stable in the PRD group. There were no significant differences in the recovery parameters and complications between the two groups. In conclusion, combining low-dose desflurane with PR may represent an efficient anesthesia regimen to prevent the hemodynamic instability of TIVA in patients undergoing laparoscopic gynecological surgery.

The clinical efficacy of laparoscope in the treatment of 86 nulliparous women with tremendous ovarian cysts

Objective To explore the clinical efficacy of laparoscope in the treatment of nulliparous women with tremendous ovarian cysts .Methods 46 cases of nulliparous women were divided into the two groups according to the operation method .23 cases in the laparoscopic surgery group received laparoscopic pneumoperitoneum needle treatment.23 cases in the open group were given the traditional open surgery .Before operation,the umbilical region and vagina of these patients were cleaned ,and antibiotics was given to the two groups .The operative time,postopera-tive bleeding,exhaust time,hospitalization time,the number of cases of postoperative pain ,menstrual conditions and recovery time of daily living activities were compared .Results The operative time of the laparotomy group was （68.3 ±12.3）min,which was significantly longer than （59.6 ±11.5）min of the laparoscopic surgery （t=4.26,P〈0.05）.The number of pain after surgery in the laparoscopic surgery group and laparotomy group were 11 cases,21 cases. The incidence rate of postoperative pain in the laparoscopic surgery group was 47.8%,which was significantly lower than 91.3% in the laparotomy group （χ2 =10.3,P〈0.05）.Conclusion Laparoscopic treatment for nulliparous women with ovarian cysts showed shorter operative time ,less blood loss ,faster exhaust time ,shorter hospital stay ,less pain and faster recovery .This surgery scheme deserved to be introduced and further studied . Key words: Ovary; Laparoscopy; Surgery ; Cyst

Injuries caused by Veress needle insertion for creation of pneumoperitoneum: a systematic literature review

The aim of this study was to assess the prevalence, risks, and outcomes of injuries caused by the Veress needle described in the literature. Iatrogenic injuries caused by Veress needle insertion during diagnostic or therapeutic laparoscopies in humans were researched, with no language restriction, in the Medline, Lilacs, Embase, Scielo, and Cochrane Library databases. The following words were combined: "Veress" or "insufflation needle" or "pneumoperitoneum needle," and "complications" or "injuries" or "lesions." The bibliographic references of the selected articles were also analyzed. We considered the following: (1) number of injuries described in the literature, (2) relationship between number of injuries and number of patients who underwent Veress needle insertion in the studies that reported Veress needle injury, (3) organs and structures injured (retroperitoneal vessels, digestive tract, and self-limited, minor injuries), and (4) outcome (death, conversion to laparotomy, laparoscopic repair, spontaneous resolution). Thirty-eight selected articles included 696,502 laparoscopies, with 1,575 injuries (0.23%), 126 (8%) of which involved blood vessels or hollow viscera (0.018% of all laparoscopies). Of the 98 vascular injuries, 8 (8.1%) were injuries to major retroperitoneal vessels. There were 34 other reported retroperitoneal injuries, but the authors were not specific as to which vessel was injured. Of the 28 injuries to hollow viscera, 17 were considered major injuries, i.e., 60.7% (0.0024% of the total cases assessed). The insertion of the Veress needle in the abdominal midline, at the umbilicus, poses serious risk to the life of patients. Therefore, further studies should be conducted to investigate alternative sites for Veress needle insertion.

Complications During Set-Up Procedures for Laparoscopy

In this retrospective study, the major complication rates that occurred during the preparatory phase of laparoscopic surgery were compared according to procedure. The first operating team habitually used a classic approach to laparoscopy and created the pneumoperitoneum before introduction of the optic trocar. A second team, located at another hospital, always performed laparoscopy that involved layer-by-layer dissection into the abdominal cavity enabling visual placement of the trocar. A retrospective review of the medical records of patients who underwent laparoscopy performed by each of these 2 teams was conducted to determine the complication rate in each group. A total of 8324 patients underwent laparoscopy using the classic technique. All laparoscopies in this group were completed successfully. There were 4 complications identified (0.05%), including 1 vascular injury and 3 bowel injuries. The vascular injury and 2 bowel injuries were recognized immediately and repaired during the operation. The fourth, a bowel injury resulting from insertion of the pneumoperitoneum needle, was not recognized until peritonitis developed postoperatively. Treatment by laparotomy was successful. There were 1562 patients in the group who had open laparoscopy. Three of these procedures had to be converted to laparotomy, 1 in a morbidly obese woman and 2 in patients who had several prior abdominal surgeries. Three major complications (0.19%) occurred in this group. Two were bowel injuries that were recognized and treated immediately. Thirty days after surgery, the third patient developed a small bowel obstruction at the site of the umbilical trocar. Bowel resection was performed.

Randomized, prospective, single-blind trial of a new parallel technique of Veress pneumoperitoneum needle insertion versus the conventional closed method

Objective: To evaluate the safety and effectiveness of a new closed parallel technique of Veress needle insertion and to compare this method with the conventional closed approach. Design: Sequential, randomized, prospective, single-blind clinical trial. Setting: University hospital. Patient(s): Women undergoing elective diagnostic and/or operative laparoscopy. Subjects (n = 200) were assigned randomly to undergo the conventional closed method (group 1; n = 100) or the new parallel technique (group 2; n = 100) of Veress needle insertion. Intervention(s): Randomization of the patients was performed in the operating room. The investigator performed both diagnostic and operative laparoscopy in both study groups. Main Outcome Measure(s): Safety and effectiveness of the needle insertion technique. Result(s): There were no significant differences in demographics between the groups, or in the time required for Veress needle insertion to establish pneumoperitoneum. There were no nonlethal major or minor intraoperative complications associated with either laparoscopic approach. Conclusion(s): There is no significant disadvantage to the parallel technique of Veress pneumoperitoneum needle insertion compared with the conventional closed approach. This new technique avoids the anatomic location of large vessels during insertion and may serve as a safeguard to decrease the potential for lethal laceration of a major vessel.

Blunt Stylet of Pneumoperitoneum Needle May Remain Retracted

Blunt Stylet of Pneumoperitoneum Needle May Remain Retracted

Major vascular injuries during laparoscopic procedures

Major vascular complications following laparoscopic procedures are rare, with only 20 cases reported in the literature. The cases of 4 patients who sustained 5 vascular injuries during laparoscopic procedures between June 1991 and May 1994 are presented, and previously reported cases in the literature are reviewed. All injuries occurred during pelvic laparoscopy (2 diagnostic procedures, 1 tubal ligation, and 1 hernia repair). The vascular injury was recognized during laparoscopy in 3 patients. In only 1 patient was immediate vascular surgery consultation requested. The iliac artery was injured in 3 patients, the iliac vein in 1, and the inferior epigastric artery in 1. The mechanism of injury was by the trocar in 2 patients and by sharp dissection in 2 patients. Arterial repair was accomplished by polytetrafluoroethylene (PTFE) interposition, PTFE patch angioplasty, resection and primary anastomosis, and ligation in 1 patient each. The venous injury was repaired by lateral venorrhaphy. Three patients recovered without sequelae, and 1 patient had a stroke. A review of the literature revealed only 20 reported cases of major vascular injuries as a result of the pneumoperitoneum needle or trocar insertion. Characteristically, the terminal aorta, cava, iliac arteries, and veins were injured. Most injuries were treated by direct suture repair. With immediate recognition, recovery was the rule; however, 3 of the 8 patients with delayed recognition died. Laparoscopists must be aware of this rare, serious, and potentially lethal complication. Once recognized, immediate conversion to an open procedure and application of appropriate vascular surgical techniques are required to reestablish arterial and venous continuity and minimize morbidity and mortality.

Fatal Carbon Dioxide Embolism Complicating Attempted Laparoscopic Cholecystectomy—Case Report and Literature Review

Laparoscopic cholecystectomy has become the surgical procedure of choice for individuals with symptomatic gallbladder disease. The procedure has gained popularity among surgeons and patients because of inconspicuous abdominal incisions/scars, less postoperative pain, shorter hospitalization, and reduced medical costs. Bile duct, vascular, and gastrointestinal iatrogenic injuries are major complications. We describe the case of a 50-year-old woman who died of CO2 embolism during elective laparoscopic cholecystectomy for symptomatic cholelithiasis. With the patient under general anesthesia, a 1.5 cm incision was made just below the umbilicus, and a pneumoperitoneum was created by CO2 insufflation with a pneumoperitoneum (modified Veress) needle. Immediately, she experienced a cardiopulmonary arrest and could not be resuscitated. At autopsy, air bubbles were admixed with blood in the epicardial veins and leptomeningeal blood vessels. A triangular 0.1 cm perforation in the left common iliac vein had been created by the pneumoperitoneum needle. A pneumoperitoneum is required for laparoscopy and CO2 is the most commonly used gas. Carbon dioxide is highly soluble in blood and fairly innocuous to the peritoneum. Small amounts absorbed into the circulation cause slight increases in arterial and alveolar CO2 and in central venous pressure. When CO2 enters the venous circulation through iatrogenically opened vascular channels, catastrophic and potentially fatal hemodynamic and respiratory compromise may result.

Experience with a 1.2-mm pneumoperitoneum needle for laparoscopy

Experience with a 1.2-mm pneumoperitoneum needle for laparoscopy

Cul-de-sac insufflation: an easy alternative route for safely inducing pneumoperitoneum.

Since 1977, routine cul-de-sac insufflation to achieve a pneumoperitoneum for laparoscopy was performed on 350 women under local anesthesia. A van Schie/van Lith intrauterine tenaculum, used together with a self-retaining Trelat speculum, guaranteed maximum stretching of the posterior vaginal fault and fixation of the anteflexed uterus necessary for an accurate 1-cm deep penetration of a pneumoperitoneum needle into the cul-de-sac. The correct position of the tip of the needle was determined precisely by means of two manometers. The failure rate in the first study of 195 procedures was 3.6% and that in the following 155 cases was 1.9%. There were no serious operative complications. The authors recommended the cul-de-sac insufflation approach for inducing pneumoperitoneum as the technique of choice.

Hematoma of the sigmoid colon as a complication of laparoscopy

A hematoma of the bowel occurring at the time of insertion of the pneumoperitoneum needle is reported. The patient was a 28-year-old nulligravida. Polycystic ovaries had been diagnosed. Ptosis of the left kidney had been noted on pelvic examination and earlier shown by intravenous urography. After failure of treatment for sterility laparoscopy and ovarian biopsy were recommended. On first insertion of the Verres needle to produce pneumoperitoneum free-flowing blood was obtained on aspiration. Reinsertion of the needle obtained no blood on aspiration. Observation of the abdominal contents after a satisfactory pneumoperitoneum showed a retroperitoneal bulge beneath the pelvic colon. Ovarian biopsy confirmed bilateral tubal patency. A hematoma 2 cm in diameter was found on the flexure of the sigmoid colon. The puncture site could also be seen. As the hematoma did not increase in size during the other procedures nothing further was done. Oral ampicillin was given. On subsequent observations the patient has remained well. As a predisposing factor elevation of the sigmoid colon by the ptosed left kidney is believed to have been important. Aspiration is needed each time the needle is advanced. Laparatomy is not needed if the hematoma remains stable. Antibiotics are advised.

Letter: Hazards of laparoscopy.

I should like to refer to the mode of introduction of the pneumoperitoneum needle. It is this part of the operation which registars find most difficult and why we suggested (June 30, p. 773) a different site for insertion in the unexceptional case. I have the greatest admiration and respect for Mr. Patrick Steptoe (August 11, p. 347) but respectfully suggest that a technique which is easier to learn is likely to be safer as far as surgical trainees are concerned. In Winchester we have found that registrars find it easier to learn the technique of inserting the needle about halfway between the symphysis pubis and the umbilicus. The operator's left hand tenses the abdominal skin while palpating the sacral promontory. The needle "plunges" into the hollow of the pelvis with a distinctive feel. It is of course, essential that the patient is in the Trendelenburg position and that an assistant holds the Spackman's cannula in such a way as to antevert the uterus as far as possible. This method is contraindicated in patients with a pelvic tumor, when a technique such as described by Mr. Steptoe is preferred. This method is quite different from the standard technique because the abdominal wall is not lifted away from the posterior abdominal wall and relies for its safety in directing the needle into the pelvic cavity. We find it useful to keep the pneumoperitneum needle in situ; it can be used to display the pelvic viscera or aspirate cysts and often avoids the need to insert another trocar and cannula. Since adopting this technique (which is not unique to Winchester) we have had no laparoscopy failures. The uterus has been punctured 3 times in about 200 operations but with no sequelae. Trainees need to be taught the several means of introducing the pneumoperitoneum needle and, like Kejlland's forceps, this means tuition by the expert.

Hazards of laparoscopy.

Comments in response to letters on the potential hazards of laparoscopy are presented. Laparoscopic instruments should be carefully checked before each procedure. The insertion of the pneumoperitoneum ne edle is important to the safety of the procedure. The needle should be inserted through the skin into the subdermal adipose layer of the abdominal wall only. The abdominal wall below the umbilicus should then be raised so that the needle may be passed through the fascia and peritoneum in a nearly horizontal direction. The needle should never be introduced with the gas source attached and flowing. The establishment of special training centers for endoscopic procedures is encouraged.