| Sub-title | |
| Authors | Y Muscat Baron J Craus C Portelli G Buttigieg M P Brincat |
| Abstract | INTRODUCTON: For most gynaecological surgeons, the initial steps towards performing a laparoscopy entail peritoneal insufflation via a Veress needle inserted through a sub-umbilical incision. This is a vital step in the successful performance of the so-called closed method laparoscopy. However, problems are frequently encountered when trying to attain adequate pneumoperitoneum. Several attempts may sometimes be required to obtain a pneumoperitoneum increasing risks for laparoscopic visceral and vascular complications, 38% of which are related to Verres needle placement. OBJECTIVE: Reduction in number of attempts at Verres needle placement while performing the closed method laparoscopy. METHODS: As opposed to the conventional method of inserting the Veress needle through a sub-umbilical incision, we employed a centrally directed intra-umbilical Veress needle insertion to attain adequate peritoneal insufflation. After obtaining sufficient pneumoperitoneum, a sub-umbilical incision would be performed and a 10mm trocar gently introduced into the peritoneal cavity. This procedure was performed on 60 consecutive cases of diagnostic and operative laparoscopy. RESULTS: Pneumoperitoneum was obtained at the first attempt in all but one case where appropriate Veress needle placement was obtained on the second attempt. Two minor difficulties involved two very thin patients whereby in one patient, gas leaked from the defect due to the Veress needle, while in the second patient gas escaped via the umbilical incision. In both cases the abdominal defects were successfully plugged and the procedure continued uneventfully. CONCLUSION: Successful first attempt Veress needle insertion appears more possible with this method of needle placement. This method takes the opportunity presented by the unique umbilical anatomy where at its base it is found to be the thinnest region of the abdominal wall. With a reduction in needle placement attempts we postulate a reduction in Veress needle related complications. |
Published in: | |
| Journal | Malta Medical Journal |
| Volume | Volume 15 (suppl) |
| Pages | - |
| Date | |
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| Key words | veress needle, sub-umbilical incision, laparoscopy, pneumoperitoneum |