Verres Needle Research Articles

Umbilical endometriosis, a pathology that a gynecologist may encounter when inserting the Veres needle

To raise awareness between laparoscopists about umbilical endometriosis and to recommend the appropriate management measure for this rare but easily treatable condition. Case reports and literature review. Women presented to general surgeon with umbilical masses. Women of reproductive age with histologic diagnosis of umbilical endometriosis. Excision with histopathologic examination. Definite diagnosis and clinical improvement. Umbilical endometriosis is best diagnosed and cured with excisional biopsy. Other diagnostic methods have been proven to be nonspecific and unreliable in the literature. Clinical diagnosis of this condition can be difficult even with the aid of cytology and imaging. Surgical excision with removal and histopathology is recommended for both diagnostic and therapeutic purposes. Simultaneous laparoscopy should be recommended to the patient with suspected pelvic endometriosis.

Visceral Sliding Technique Is Useful for Detecting Abdominal Adhesion and Preventing Laparoscopic Surgical Complications

Study Objective: Introduce a non-invasive method preoperatively to prevent bowel injury by the Veres needle and trocar during laparoscopy. Design: Case-controlled study. Setting: A hospital-based study. Patients: Five hundred and twelve patients who underwent laparoscopic surgery were prospectively enrolled. Intervention: A simple and non-invasive method to detect bowel adhesions preoperatively. Results: A total of 512 patients who underwent operative laparoscopy were prospectively enrolled for ultrasonographic visceral sliding evaluation. They were subdivided into two groups as follows: group I, 332 patients without previous abdominal surgery; group II, 180 patients with previous abdominal surgery. No bowel adhesion to the umbilicus was present in group I. In group II, only two cases with bowel adhered to the periumbilical area were found by visceral sliding technique. No patients suffered any bowel injury. Conclusion: The proposed technique is useful and highly effective in guiding the insertion of the Veres needle and trocar to prevent bowel injury in laparoscopy.

Unilateral vulvar emphysema after operative laparoscopy

F Subcutaneous emphysema is defined as the presence f air or gas in the subcutaneous tissues. It is associated ith respiratory conditions, trauma, and surgery. It can lso occur during laparoscopy, either as a result of inorrect insertion of the Veres needle or from improper rocar placement. We report the case of a 30-year-old woman who unerwent an elective laparoscopy for pelvic pain. Entry as uncomplicated, and we performed a routine threeort laparoscopy. After a thorough inspection of the pelis, the left pelvic side wall underwent biopsy to exclude elvic endometriosis. Midway through the dissection, a

Is the verres needle an acceptable inflation tool to measure the abdominal pressure-volume relation?

Is the verres needle an acceptable inflation tool to measure the abdominal pressure-volume relation?

The ABCs of a safer laparoscopic entry

It is well known that at least 50% of laparoscopic complications occur during the initial entry into the abdomen regardless of the method used. There is evidence that most gynecologists practice the "classic" or closed laparoscopic entry. There is no evidence that the closed entry is more or less dangerous than the other existing methods of entry. Entry-related complications have been minimized by the following three steps: low initial Veres intraperitoneal pressure indicating correct placement of the Veres needle; transient high-pressure pneumoperitoneum before primary trocar/cannula insertion; and visual entry with the Ternamian cannula. Following the above steps, no entry complications have been encountered by the author in more than 3000 consecutive laparoscopies.

Effect of body habitus and parity on insufflated CO 2 volume at various intraabdominal pressures during laparoscopic access in women

Study objective To determine height, weight, body mass index (BMI), parity, and age effect on the volume of CO 2 pneumoperitoneum during laparoscopic access in women. Design Prospective observational cohort study (Canadian Task Force classification II-1). Setting University-affiliated teaching hospital. Patients From January through June 2004, 100 healthy women underwent operative laparoscopic surgery consecutively by the senior author (GAV). Indications were: chronic pelvic pain (CPP, n = 66), pelvic mass (n = 7), CPP and pelvic mass (n = 4), infertility (n = 23). Median (range) height, weight, BMI, parity and age were 1.65 m (1.45–1.85m), 70 kg (43–118 kg), 25.5 kg/m 2 (17–39 kg/m 2), 1.1 (0–5), and 34 years (19–58 years), respectively. Interventions While in supine position, patients received general endotracheal anesthesia and muscle relaxants. Pneumoperitoneum was established by reusable Veres needle. The insufflated CO 2 volume was serially recorded at intraperitoneal insufflation pressures (IPIPs) of 10, 15, 20, 25, and 30 mm Hg. The primary 10-mm trocar was introduced at IPIP of 30 mm Hg. Upon entering the peritoneal cavity, the abdominal contents were visualized with the laparoscope to ensure there was no injury, and the IPIP was immediately reduced back to the operating pressure of 15 mm Hg before switching the patient to the Trendelenburg position. Measurements and main results The mean (SD) insufflated CO 2 volumes at 10, 15, 20, 25, and 30 mm Hg were 1.7 (0.74) L, 3.1 (0.9) L, 3.96 (1.05) L, 4.42 (1.1) L and 4.72 (1.14) L, respectively. Using multivariate analysis, we demonstrated that at 20 to 30 mm Hg the insufflated CO 2 volume correlated positively with the height, weight and BMI of women. Parity correlated positively at all pressures. There was no correlation with age at any pressure. Conclusions Higher CO 2 volume is required to establish appropriate pneumoperitoneum in tall, overweight, and parous women at 20 to 30 mm Hg. Setting the IPIP at 20 to 30 mm Hg before primary trocar insertion eliminates the need to monitor CO 2 insufflated volume regardless of women’s age, parity, and body habitus.

Effect of body habitus and parity on the initial Veres intraperitoneal CO 2 insufflation pressure during laparoscopic access in women

Study objectives Since most gynecologists use the Veres/trocar entry, and because the Veres intraperitoneal (VIP) pressure appears to be the most reliable indicator of correct Veres needle placement, the objective of this study was to determine the effect of height, weight, body mass index (BMI), parity, and age on the initial Veres intraperitoneal CO 2 insufflation pressure during laparoscopic access in women. Design Prospective observational cohort study (Canadian Task Force classification II-1). Setting University affiliated teaching hospital. Patients We prospectively collected data on 356 women undergoing laparoscopy for a variety of indications by the senior author (G.A.V.). The median and (range) for height, weight, BMI, parity, and age were 1.64 m (1.45–1.85 m), 65 kg (40–120 kg), 24.3 kg/m 2 (16–47 kg/m 2), 1 (0–5) and 34 years (18–87 yrs), respectively. Intervention Under general endotracheal anesthesia including muscle relaxants and with the patient in appropriate stirrups in the horizontal position, a nondisposable Veres needle was inserted at the umbilicus or left upper quadrant (Palmer’s point) with CO 2 flowing at 1 L/min. The initial Veres intraperitoneal insufflation pressure was recorded once the Veres needle was believed to be in the peritoneal cavity. Measurements and main results The mode and the median VIP pressure was 4 mm Hg with a range of 2 to 10 mm Hg. With multivariate analysis, the VIP pressure correlated positively with the weight (r = 0.518, p <.001) and BMI (r = 0.545, p <.001) and negatively with the parity (r = −0.179, p <.001) of women. The correlation of the VIP pressure with height and age was r = 0.029 (p = .591) and r = −0.044 (p = .411), respectively. Conclusion A VIP pressure ≤10 mm Hg indicates intraperitoneal placement of the Veres needle. The VIP pressure correlates positively with the weight and BMI and negatively with the parity of women. There is no correlation of the VIP pressure with women’s height and age.

Positioning the Verres needle

Journal Article Positioning the Verres needle Get access S P Gupta S P Gupta Unit III, RNT Medical College and Hospital, Udaipur-313001, India Correspondence to: Dr S. P. Gupta Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 76, Issue 4, April 1989, Page 381, https://doi.org/10.1002/bjs.1800760421 Published: 06 December 2005 Article history Accepted: 21 October 1988 Published: 06 December 2005

High-pressure laparoscopic entry does not adversely affect cardiopulmonary function in healthy women

Study objective To determine hemodynamic and pulmonary compliance changes during laparoscopic entry using transient hyperinsufflated pneumoperitoneum. Design Prospective observational cohort study (Canadian Task Force classification II-1). Setting University-affiliated teaching hospital. Subjects From January through June 2004 one hundred healthy women underwent operative laparoscopy consecutively. Indications included chronic pelvic pain (CPP, N = 66), pelvic mass (N = 7), CPP and pelvic mass (N = 4), primary or secondary infertility (N = 23). The mean age was 34 years (range, 19-58) and the mean BMI 25.5 kg/m 2 (range, 17.1-39.4). Interventions With the patients under general anesthesia, muscle relaxants, and in supine position, pneumoperitoneum was established using a Veres needle. The following information was prospectively collected at different intraperitoneal insufflation pressures (IPIP): CO 2 volume, heart rate, blood pressure, and pulmonary compliance. At IPIP of 30 mm Hg the primary trocar was inserted and the IPIP was immediately reduced back to the operating pressure of 15 mm Hg. Measurements and main results The mean initial IPIP was 4.7 mm Hg (range, 2-9 mm Hg). The mean volume of CO 2 at IPIP of 10, 15, 20, 25, and 30 mm Hg was 1.7, 3.1, 4, 4.4, and 4.7 L, respectively. There was no statistically significant change in the heart rate or pulse pressure between IPIP of 15 and 30 mm Hg. The difference in CO 2 volume (1.6 L) required to achieve IPIP of 15 and 30 mm Hg was statistically significant (p < 0.0001). A statistically significant increase of 7 mm Hg in the mean arterial pressure (MAP) was found between IPIP of 15 & 30 mm Hg (p < 0.0001). The additional 21% drop in pulmonary compliance from IPIP 15 to 30 mm Hg was statistically significant (p < 0.0001). This decrease in pulmonary compliance was well tolerated by the patients, and the oxygen saturation remained above 92% in all cases. The elevated MAP was not clinically significant. Conclusion The use of transient hyperinsufflated pneumoperitoneum caused minor hemodynamic alterations which were not clinically significant. The alterations in pulmonary compliance were statistically significant; however, they had no clinical significance and were tolerated well by healthy women.

Female sterilisation: a cohort controlled comparative study of ESSURE versus laparoscopic sterilisation

To compare patient satisfaction, discomfort, procedure time, success rate and adverse events of hysteroscopic (ESSURE, Conceptus Inc, San Carlos, USA) versus laparoscopic sterilisation. Cohort controlled comparative study. The day surgery and outpatient unit of three large UK hospitals. Eighty-nine women requesting sterilisation were enrolled into the study. A 2:1 ratio of ESSURE placement to laparoscopic sterilisation was undertaken. Laparoscopic sterilisation was carried out under general anaesthesia in the day surgery unit whereas all ESSURE procedures were carried out in a dedicated outpatient facility. All patients completed a self-assessment diary on days 7 and 90 post-operatively. Patient satisfaction, tolerance and discomfort were measured using an ordinal Likert style scale. Data were analysed using the chi(2) test for statistical significance. The primary outcome measure is patient satisfaction with ESSURE versus laparoscopic sterilisation. This included satisfaction with the decision to proceed with the relevant sterilisation method, recovery from the procedure and overall satisfaction following either ESSURE or laparoscopic sterilisation. Secondary outcome measures include successful completion of procedure, procedure time, tolerance, patient discomfort and post-operative adverse events. All women who underwent laparoscopic sterilisation had the procedure successfully completed whereas the overall bilateral device placement rate for ESSURE was 81%. Patient satisfaction with their decision to undergo either ESSURE or laparoscopic sterilisation was high with 94% of the ESSURE group being 'very' or 'somewhat' satisfied at 90 days post-procedure versus 80% in the laparoscopic sterilisation group. At 90 days post-procedure 100% of women in the ESSURE group were 'very satisfied' with their speed of recovery versus 80% in the laparoscopic sterilisation group. The procedure time (defined from the time of insertion of the hysteroscope or laparoscope to its removal) took significantly longer for ESSURE than laparoscopic sterilisation (mean = 13.2 vs 9.7 minutes, P= 0.045). However, the time required for insertion of a Verres needle and insufflation of the abdominal cavity is a necessary part of the laparoscopic sterilisation and had it been included would bring the procedures times more in line with each other. The mean time spent in hospital was significantly shorter for the ESSURE group than the laparoscopic group (188.7 vs 396.1 minutes, P < 0.005). Eighty-two percent of women in the ESSURE group described their tolerance of the procedure between 'good and excellent' compared with only 41% of the laparoscopic sterilisation group (P= 0.0002). Only 31% of the ESSURE group reported moderate or severe pain following the procedure compared with 63% of the laparoscopic sterilisation group (P= 0.08). Only 11% of patients had problems immediately post-operatively in the ESSURE group compared with 27% in the laparoscopy group. Finally, in the more medium term (three months post-operatively), patients still had an advantage in terms of post-procedure adverse events in the ESSURE group (21%vs 50%). This study provides evidence that ESSURE can be performed in the majority of women and, when successful, is associated with a greater overall patient satisfaction rate than laparoscopic sterilisation. Women also spend less time in hospital, have better tolerance of the procedure and describe less severe post-operative pain. However, the devices cannot be bilaterally placed in all cases and some women do not tolerate the procedure awake.

An evaluation of four tests used to ascertain Veres needle placement at closed laparoscopy

To determine the reliability of four commonly used tests to confirm the placement of the Veres needle during closed laparoscopy and their ability to determine other complications of entry. A prospective observational study (Canadian Task Force classification II-2). A university-affiliated teaching hospital in Sydney, Australia. Three hundred forty-five women undergoing closed laparoscopy using Veres needle peritoneal insufflation. The double click test, the hanging drop test, the aspiration test, and the initial five pressures at the time of insufflation following Veres needle placement were assessed for their sensitivity, specificity, and positive and negative predictive values for correct intraperitoneal placement of the needle and the presence or absence of any complication such as preperitoneal insufflation, omental emphysema, or visceral injury. Complications occurred in 65 (18.8%) of 345 women, with preperitoneal insufflation in 19 (5.5%) of the 345, a superficial gastric injury in 1 (0.3%), and omental emphysema in 45 (13%). There was poor sensitivity and positive predictive values for preinsufflation tests. The first five pressures after commencement of insufflation were a sensitive predictor (79%) of complications, particularly preperitoneal insufflation (100% sensitivity for this complication). When two or more passes of the Veres were required, there was a significantly greater chance of preperitoneal insufflation (chi2 = 20.5, p <.0001). Preperitoneal insufflation was not reported when the first five successive insufflation pressures were less than 10 mm Hg. The double click, aspiration, and hanging drop tests provide very little useful information on the placement of the Veres needle at the time of closed laparoscopy. The initial gas pressures provide considerable information on the placement of the Veres needle, in particular the likelihood of preperitoneal insufflation. We conclude that the initial gas pressure is the only valuable measure to reflect correct intraperitoneal Veres needle placement.

Previous Abdominal Surgery and Closed Entry for Gynecologic Laparoscopy: A Prospective Study

All gynecologic laparoscopic procedures performed at the authors' institution in the 12-month period from January 2000 to January 2001 were entered into a comparison trial of complications from laparoscopy in women with no prior abdominal surgery (group I, n = 368) and women with a history of previous abdominal surgery (group II, n = 109). Standard laparoscopic techniques were used for all procedures. In group I, the initial insertion of the Verres needle was made in the umbilicus. After 2 unsuccessful attempts, the location of the Verres needle placement was changed to the right upper quadrant. In group II, the initial insertion of the Verres needle was in the left upper quadrant 2 to 3 cm inferior to the middle of the last rib. After 2 unsuccessful attempts, the procedure was converted to open laparoscopy. There were no complications in group I. All complications, both major, which were defined as vascular or visceral injuries, and minor, defined as failure or unsatisfactory achievement of pneumoperitoneum, occurred in women who had undergone previous abdominal surgery. The only major complication was a bowel injury, which was associated with insertion of the Verres needle. It was repaired laparoscopically. Minor injuries included 13 (12%) failures to create the pneumoperitoneum, 17 (16%) subperitoneum insufflations, 12 (11%) emphysemas of the omentum, and 2 (1.8%) subperitoneal insertions of the umbilical laparoscopic trocar. In 19% of cases, several attempts at insertion of the Verres needle were necessary. In all, there were 2 attempts at insertion in 11%, 3 in 5%, and 4 in 1%.

Complications associated with cannula insertion techniques used for laparoscopy in standing horses.

To report our experience and complications associated with different cannula insertion techniques for laparoscopy in standing horses. Retrospective study. Forty horses that had laparoscopy for diagnostic or surgical purposes. After a physical examination, including rectal palpation, standing laparoscopy was performed in 40 sedated horses. Local anesthetic was injected at each site of cannula insertion in the left flank. Horses were divided into 5 groups: Pneumoperitoneum was induced before cannula insertion using a Verres needle (group 1, n = 3) or a 12-g catheter (group 2, n = 14); the cannula was inserted before inducing a pneumoperitoneum (group 3, n = 9); the cannula was inserted under visual control, using an operating laparoscope (group 4, n = 2) or a Visiport Optical Trocar (group 5, n = 12). Horses were observed for 7 days. Problems with insufflation or cannula insertion occurred in 12 horses: 6 had peritoneal detachment, 4 had a splenic puncture, and 2 had descending colon puncture. Eleven of these complications occurred in groups 1 to 3 and only 1 in groups 4 and 5. The Visiport optical device allows controlled insertion of the initial trocar, and thus avoided potential problems associated with "blind" cannula insertion techniques and was used effectively in horses that had feed withheld for 12 hours. This technique enables direct insertion of a cannula directly into the right flank. Complications associated with initial cannula insertion in the paralumbar fossa, for laparoscopy, in standing horses can be minimized with the use of an optical cannula.

Safe entry techniques during laparoscopy: Left upper quadrant entry using the ninth intercostal space—A review of 918 procedures

Surgeons performing sophisticated endoscopic operations must be well versed in alternate laparoscopic access methods to address evolving patient expectations and safety requirements. The safety of left upper quadrant laparoscopic entry in patients with prior surgeries and abdominal adhesions was evaluated. Laparoscopic surgery was performed for various indications on patients with prior surgical scars and anticipated risk of adhesions at the primary umbilical port site. All laparoscopies performed from July 1998 through June 2004 were analyzed. Of the 918 laparoscopies, 504 patients (54.9%) were found to have involvement of their umbilicus with adhesions that could have affected the traditional umbilical primary port entry. Left ninth intercostal space was used for Veres needle entry, and the primary trocar was placed in the left upper quadrant space. Of the 504 potentially risky entries, there were two (0.39%) Veres-needle related and zero trocar-related injuries. All surgical procedures were accomplished laparoscopically, and all entries were accomplished by the left upper quadrant entry technique. Therefore left upper quadrant entry technique is a safe and easily learned alternate access technique.

Previous abdominal surgery and closed entry for gynaecological laparoscopy: a prospective study

To assess the morbidity from closed laparoscopic access and define the role of previous surgery on the occurrence of these complications. We prospectively recorded data on all laparoscopic procedures between January 2000 and January 2001. We compared results from patients without previous abdominal surgery (group I) with patients with prior abdominal surgery (group II). The insertion site for the Verres needle was trans-umbilical for patients in group I and in the left upper quadrant for patients in group II. Gynaecology department of a University Hospital. All laparoscopic procedures between January 2000 and January 2001. We compared results from patients without previous abdominal surgery (group I) with patients with prior abdominal surgery (group II). The insertion site for the Verres needle was trans-umbilical for patients in group I and the left upper quadrant for patients in group II. Four hundred and seventy-seven laparoscopies were carried out during the study period, 368 women without previous surgery were included in group I, and 109 women were included in group II. We recorded 1 complication (overall complication rate of 0.2% and 31 incidents (6.4%). One complication (small bowel injury) was related to the insertion of the Verres needle (0.2%). The incidents and complications occurred only in group II (P < 0.05). All the complications were treated by laparoscopy. The complication rate of the entry step is low in gynaecological laparoscopy. A previous history of laparotomy increases the risk of these complications and incidents. Safety rules and other access method should be investigated for these patients.

Laparoscopic inguinal hernia repair--how I do it.

Initial entry to the abdomen is by direct puncture at the umbilicus.1 Briefly, the umbilicus is firmly elevated with Lane’s tissue holding forceps and the very centre of the umbilicus incised with a 23 Swann Morton scalpel blade. Usually, the blade incises the fascia but often does not divide the peritoneum. Artery forceps are introduced through the incision to bluntly break through the peritoneum and a 10 mm laparoscopic cannula is introduced over a blunt tipped trocar (soon to be available from Karl Storz, Tuttlingen, Germany). Alternative entry methods are the cut down technique described by Hasson and the use of a Verres needle to create the pneumoperitoneum.

The use of trans-vaginal laparoscopy in ruling out pelvic malignancy: a case report

Trans-vaginal laparoscopy (TVL) was performed in a patient at high risk for ovarian cancer (OC). During a routine check-up vaginal sonography and color Doppler studies revealed neoangiogenesis with low resistance in both sides. The left ovary was slightly enlarged, and the increased blood vessels were seen in the center and in the periphery of the left ovary. The patient was placed in the lithotomy position after sedation, and a veres needle was inserted in the posterior vaginal vault. A trocar followed, and warm normal saline was injected in the pelvis. The needle was removed, and a telescope was introduced, connected to a light source and a monitor. Excellent visualization was achieved, and the average time of TVL was 30 min. Dilated veins in both adnexa and pelvic tissues due to severe obesity were visualized. TVL helped in establishing the diagnosis, saving this patient from an unnecessary laparoscopy or laparotomy.

Complications of gynaecological laparoscopy--a retrospective analysis of 3572 cases from a single institute

Three thousand, five hundred and seventy-two laparoscopic procedures were analysed retrospectively from a single institution between 1996 and 2003. Operations were classified into four groups as diagnostic laparoscopy (386, 10.8%), minor (1092, 30.5%), major (1866, 52.4%) and advanced (228, 6.5%) laparoscopic procedures. Overall, 67 (1.88%) complications occurred. The complication rates were 1.81%, 1.37%, 1.82% and 4.82% in the respective groups. One death (0.03%) occurred due to aortic injury during insertion of the principal intraumbilical trocar. Complications during insertion of the Verres needle, principal and accessory trocars were noted in 25 cases (38.2%) and were comparable among the four groups. Intraoperative complications occurred in 32 patients (47.8%) encountered mainly in the major and advanced groups. Overall, acute postoperative complications occurred in 10 (14.9%) patients. Despite advanced technology and experience, complications during the installation phase of laparoscopy remain a major cause of significant morbidity and most operative complications occurred in advanced operative procedures. Complications associated with all types of laparoscopic procedures should not be underestimated.

Complications associated with cannula insertion techniques used for laparoscopy in standing horses

Objective—To report our experience and complications associated with different cannula insertion techniques for laparoscopy in standing horses.Study Design—Retrospective study.Sample Population—Forty horses that had laparoscopy for diagnostic or surgical purposes.Methods—After a physical examination, including rectal palpation, standing laparoscopy was performed in 40 sedated horses. Local anesthetic was injected at each site of cannula insertion in the left flank. Horses were divided into 5 groups: Pneumoperitoneum was induced before cannula insertion using a Verres needle (group 1,n = 3) or a 12‐g catheter (group 2,n = 14); the cannula was inserted before inducing a pneumoperitoneum (group 3,n = 9); the cannula was inserted under visual control, using an operating laparoscope (group 4,n = 2) or a Visiport Optical Trocar (group 5,n = 12). Horses were observed for 7 days.Results—Problems with insufflation or cannula insertion occurred in 12 horses: 6 had peritoneal detachment, 4 had a splenic puncture, and 2 had descending colon puncture. Eleven of these complications occurred in groups 1 to 3 and only 1 in groups 4 and 5.Conclusions—The Visiport optical device allows controlled insertion of the initial trocar, and thus avoided potential problems associated with “blind” cannula insertion techniques and was used effectively in horses that had feed withheld for 12 hours. This technique enables direct insertion of a cannula directly into the right flank.Clinical Relevance—Complications associated with initial cannula insertion in the paralumbar fossa, for laparoscopy, in standing horses can be minimized with the use of an optical cannula.

Laparoscopic Gonadectomy in Pediatric and Adolescent Girls with Intersex Disorders

Obstetrical & Gynecological Survey: August 2003 - Volume 58 - Issue 8 - p 535-536 doi: 10.1097/01.OGX.0000079657.20002.F5