1
|
Bektaş O, Çelik H. The Importance of Lumbar Lordosis during Laparoscopic Trocar Entry. J Minim Invasive Gynecol 2024:S1553-4650(24)00154-7. [PMID: 38527703 DOI: 10.1016/j.jmig.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 03/03/2024] [Accepted: 03/17/2024] [Indexed: 03/27/2024]
Abstract
STUDY OBJECTIVE Investigating the effect of lumbar lordosis on the relationship between abdominal trocar entry points and major vascular structures. DESIGN Retrospective cohort. SETTING Tertiary referral center. PATIENTS Distances between the skin and the aorta and inferior vena cava at the trocar entry points, both at the umbilicus and 3 cm and 5 cm superior to the umbilicus, were measured at entry angles of 90 and 45 degrees in 101 abdominal computer tomography images. INTERVENTIONS The relationship of these values with lumbar lordosis was investigated concerning menopausal status, body mass index (BMI), and parity differences. To assess the isolated effect of lumbar lordosis, a simulated 30-degree increase in the lordosis angle was applied to the patients' computed tomography images. The impact of this increased lumbar lordosis angle on the distances between the skin and major vessels was then evaluated at both the umbilical and supraumbilical trocar entry sites. MEASUREMENTS AND MAIN RESULTS In the tomographic images of all patients, the distances from the skin to vascular structures were measured at a 90-degree entry angle, resulting in measurements of 8.97 cm ± 2.81 at the umbilicus, 10.89 cm ± 3.02 at 3 cm above the umbilicus, and 11.36 cm ± 2.88 at 5 cm above the umbilicus. These distances exhibited significant differences between patients with BMI <30 and BMI ≥30, as well as between premenopausal and postmenopausal patients. However, at a 45-degree entry angle, vascular structures were observed in only a few patients during trocar projection, and no measurable values were determined. In the simulation, it was found that a 1-degree increase in lumbar lordosis angle resulted in a decrease of 0.272 mm ± 0.018 in the distance between the skin and vascular structures at the umbilicus, 0.425 mm ± 0.024 at 3 cm above the umbilicus, and 0.428 mm ± 0.024 at 5 cm above the umbilicus. CONCLUSION An increase in the degree of lumbar lordosis reduces the distance between trocar entry points and major vascular structures. Along with other factors during Veress and trocar entry, lumbar lordosis should be carefully considered.
Collapse
Affiliation(s)
- Onur Bektaş
- Department of Obstetrics and Gynecology, Gynecologic Oncology (Onur Bektaş), Ruhr University Bochum, Herford Clinic, Herford, Germany.
| | - Hüsnü Çelik
- Department of Obstetrics and Gynecology, Gynecologic Oncology, (Hüsnü Çelik), Başkent University, Adana, Turkey
| |
Collapse
|
2
|
Afsar S, Usta CS, Usta A, Lafcı D, Gunay I, Karabudak CB. Teres lift-up technique: a retrospective comparative study for an alternative route for laparoscopic entry in gynecologic and oncologic surgery. Arch Gynecol Obstet 2023; 308:1549-1554. [PMID: 37650933 DOI: 10.1007/s00404-023-07191-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/13/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE Laparoscopic surgery is the favored method for the surgical treatment of gynecologic diseases and malignancies. We have defined an anatomic landmark-based, easy-to-perform, and an alternative way of open laparoscopic entry technique named the ligamentum teres lift-up technique (TLU) that can be used in obese or normal-weight women to tackle the risks of the closed laparoscopic entry technique, namely, Veress needle entry (VNE). STUDY DESIGN In this retrospective comparative study, the participants were equally distributed to either the TLU group (n = 36) or the VNE group (n = 36) in a 1:1 ratio. The participants were stratified according to their BMI as follows: BMI between 20-25 kg/m2 (average weight), 25-30 kg/m2 (overweight), 30-35 kg/m2 (class I obesity), and 35-40 kg/m2 (class II obesity). Both laparoscopic access techniques were compared according to the entry time, vascular or visceral injuries, insufflation failures, trocar-related complications, and omental damage. RESULTS The TLU group had a considerably shorter entry time than the VNE group (74.43 ± 21.45 s versus 192.73 ± 37.93 s; p < 0.001). Only one failed insufflation occurred in the VNE group (p = 0.32); however, that case was successfully insufflated with the TLU technique. Only one intestinal injury was seen in the VNE group, encountered during trocar site closure (p = 0.32). The subgroup analyses of the TLU and VNE groups based on BMI strata revealed a continuation of the statistical significance of entry time between BMI-matched groups. CONCLUSION The current study reveals that the new alternative TLU technique supplies an alternative, validated, and rapid access to the abdominal cavity in normal-weight and obese women. This new approach offers an easy-to-teach and easy-to-perform technique for surgical mentors and residents in gynecologic and oncologic surgeries.
Collapse
Affiliation(s)
- Selim Afsar
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Balıkesir University, Cagis Yerleskesi, Bigadic yolu 17 km, 10145, Balikesir, Turkey.
| | - Ceyda Sancaklı Usta
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Balıkesir University, Cagis Yerleskesi, Bigadic yolu 17 km, 10145, Balikesir, Turkey
| | - Akın Usta
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Balıkesir University, Cagis Yerleskesi, Bigadic yolu 17 km, 10145, Balikesir, Turkey
| | - Duygu Lafcı
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Medicine, Balıkesir University, Cagis Yerleskesi, Bigadic yolu 17 km, 10145, Balikesir, Turkey
| | - Izel Gunay
- Deptment of Obstetrics and Gynecology, Health Sciences University, Istanbul, Turkey
| | - Can Berk Karabudak
- Deptment of Obstetrics and Gynecology, Health Sciences University, Istanbul, Turkey
| |
Collapse
|
3
|
Elnaggar AA, Diab KR, El-Hangour BA, Kamel IS, Farhat AM, Abdelsattar AT, Zarad MS. Direct trocar insertion vs. Veress needle technique in laparoscopic surgeries. A systematic review and meta-analysis. J Visc Surg 2023; 160:337-345. [PMID: 36842955 DOI: 10.1016/j.jviscsurg.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
AIM To compare the safety and efficacy between Veress needle insertion and direct trocar insertion in laparoscopic surgeries. METHODS Relevant clinical trials were retrieved from major databases; Web of Science, Cochrane CENTRAL, PubMed, and SCOPUS. The following outcomes were pooled for analysis: failed entry, extraperitoneal insufflation, vascular lesion, omental lesion and visceral lesion, site bleeding, reintervention, subcutaneous emphysema, solid organ lesion, and infection of the trocar site. A fixed-effects model was used to analyze homogeneous outcomes, whereas random-effects models were used to analyze heterogeneous outcomes. RESULTS We included a total of twelve clinical trials. The pooled analysis showed that the Veress needle was accompanied by a significant increase in the incidences of extraperitoneal insufflation (RR = 0.204; 95% Cl [0.136, 0.307], P=0.001), omental lesion (RR=0.444 95% Cl [0.239, 0.825], P=0.01), and failed entry (RR=0.169 95% Cl [0.101, 0.284], P=0.001). There is no significant difference between both cohort regarding the vascular lesion (RR=0.847 95% Cl [0.259, 2.777), P=0.7), infection of the trocar site (RR=0.583 95%Cl [0.106, 3.216], P=0.5, and visceral lesion (RR=1.308 95% Cl [0.314, 5.438], P=0.7. CONCLUSION The DTI was accompanied by a significantly lower incidence of complications such as extraperitoneal insufflation, failed entry, omental lesion, and subcutaneous emphysema. On the other hand, both cohorts showed similar results regarding; vascular lesions, visceral lesions, reintervention, site bleeding, and solid organ lesion.
Collapse
Affiliation(s)
- A A Elnaggar
- Department of General Sugery, Faculty of medicine, Fayoum University, Fayuom, Egypt
| | - K R Diab
- Department of General Sugery, Faculty of medicine, Fayoum University, Fayuom, Egypt
| | - B A El-Hangour
- Department of General Sugery, Faculty of medicine, Al-Azhar University, Cairo, Egypt
| | | | - A M Farhat
- Faculty of Medicine, Fayoum University, Fayoum, Egypt.
| | | | - M S Zarad
- Department of General Sugery, Faculty of medicine, Al-Azhar University, Cairo, Egypt
| |
Collapse
|
4
|
Orsi F, Maiettini D, Bagnardi V, Azziz R. Prospective Cohort Study Quantifying the Effect of the LevaLap 1.0 on the Distance between the Abdominal Wall and Intra-abdominal Viscera. J Minim Invasive Gynecol 2023; 30:748-756. [PMID: 37192723 DOI: 10.1016/j.jmig.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/18/2023]
Abstract
STUDY OBJECTIVE More than 13 million laparoscopic procedures are performed globally every year. The LevaLap 1.0 device may facilitate safe abdominal access when using the Veress needle for initial abdominal insufflation during laparoscopic surgery. We undertook this study to test the hypothesis that use of the LevaLap 1.0 would increase the distance from the abdominal wall to underlying viscera and the retroperitoneum, including from major vessels. DESIGN Prospective cohort study. SETTING Referral center. PATIENTS Eighteen patients scheduled to undergo an interventional radiology procedure under general anesthesia and muscle relaxation. INTERVENTIONS Application of the LevaLap 1.0 device on the umbilicus and on Palmer's point, during computed tomography scanning. MEASUREMENTS Distance from the abdominal wall to the underlying bowel and to retroperitoneal blood vessels and more distant intra-abdominal organs before and after vacuum was applied to the LevaLap 1.0. MAIN RESULTS The device did not significantly increase the distance from the abdominal wall to the immediate underlying bowel. Alternatively, the LevaLap 1.0 created a significant increase in the distance between the abdominal wall at the access point and more distant intra-abdominal organs at the umbilicus and at Palmer's point (mean ± SD: +3.91 ± 2.32 cm, p = .001, and +3.41 ± 3.12 cm, p = .001, respectively). At the umbilicus, the device increased the distance between the abdominal wall and the anterior wall of the vena cava by +5.32 ± 1.22 cm (p = .004) or the anterior wall of the aorta by 5.49 ± 1.40 cm (p = .004). At Palmer's point, the device increased the distance between the anterior abdominal wall and the colon and/or small bowel by 2.13 ± 1.81 cm (p = .023). No adverse events were reported. CONCLUSIONS The LevaLap 1.0 increased the distance between abdominal wall and major retroperitoneal blood vessels by >5 cm, promoting safer access during Veress needle insufflation when performing laparoscopic surgery.
Collapse
Affiliation(s)
- Franco Orsi
- Department of Interventional Radiology (Drs. Orsi and Maiettini), IRCCS Istituto Europeo di Oncologia, Milan, Italy
| | - Daniele Maiettini
- Department of Interventional Radiology (Drs. Orsi and Maiettini), IRCCS Istituto Europeo di Oncologia, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods (Dr. Bagnardi), University of Milan-Bicocca, Milan, Italy
| | - Ricardo Azziz
- Department of Obstetrics and Gynecology (Dr. Azziz), Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Medicine (Dr. Azziz), Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Health Policy (Dr. Azziz), Management and Behavior, School of Public Health, University at Albany, SUNY, Rensselaer, New York; Department of Healthcare Organization and Policy (Dr. Azziz), School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
| |
Collapse
|
5
|
Taliento C, Pontrelli G, Rondoni A, Desgro M, Steinkasserer M, Scutiero G, Vizzielli G, Greco P. Major and minor complications in Veress needle (VN) and direct trocar insertion (DTI) for laparoscopic closed-entry techniques: an updated systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:152. [PMID: 37069276 DOI: 10.1007/s00423-023-02891-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/09/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVE Direct insertion of the trocar is an alternative method to Veress needle insertion for the creation of pneumoperitoneum. We conducted a systematic review and meta-analysis to compare these two entry closed techniques. DATA SOURCE A systematic review of the literature was done on PubMed, MEDLINE, Embase, Scopus, and EBSCO. METHODS The literature search was constructed until May 01, 2022, around search terms for "Veress," "direct trocar," "needle," "insertion," and "laparoscopic ways of entry." This systematic review was reported according to the PRISMA Statement 2020. RESULTS Sixteen controlled trials (RCTs) and 5 observational studies were included in the systematic review. We found no significant differences in the risk of major complication during the access manoeuvres between DTI and VN: bowel injuries (OR = 0.76, 95% CI: 0.24-2.36, P = 0.63), major vascular injuries (OR = 1.74, 95% CI 0.56-5.38, P = 0.34), port site hernia (OR = 2.41, 95% CI: 0.28-20.71, P = 0.42). DTI has a lower risk of minor complications such as subcutaneous emphysema (OR = 5.19 95% CI: 2.27-11.87, P < 0.0001), extraperitoneal insufflation (OR = 5.93 95% CI: 1.69-20.87, P = 0.006), omental emphysema (OR = 18.41, 95% CI: 7. 01-48.34, P < 0.00001), omental bleeding (OR = 2.32, 95% CI: 1.18-4.55, P = 0.01), and lower number of unsuccessful entry or insufflation attempts (OR = 2.25, 95% CI: 1.05-4.81, P = 0.04). No significant differences were found between the two groups in terms of time required to achieve complete insufflation (MD = - 15.53, 95% CI: - 91.32 to 60.27, P = 0.69), trocar site bleeding (OR = 0.66, 95% CI, 0.25-1.79, P = 0.42), and trocar site infection (OR = 1.19, 95% CI, 0.34-4.20, P = 0.78). CONCLUSION There were no statistically significant differences in the risk of major complications during the access manoeuvres between DTI and VN. A lower number of minor complications were observed in DTI compared with those in Veress access.
Collapse
Affiliation(s)
- C Taliento
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Ferrara, Italy.
| | - G Pontrelli
- Policlinico Abano Terme, Abano Terme, Padua, Italy
| | - A Rondoni
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Ferrara, Italy
| | - M Desgro
- Policlinico Abano Terme, Abano Terme, Padua, Italy
| | - M Steinkasserer
- Department of Obstetrics and Gynecology, Bolzano Hospital, Bolzano, Italy
| | - G Scutiero
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Ferrara, Italy
| | - G Vizzielli
- Department of Medical Area (DAME), Clinic of Obstetrics and Gynecology, University of Udine, Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - P Greco
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Ferrara, Italy
| |
Collapse
|
6
|
Casanova J, Filipe Cunha J, Proença S, Chi D. "Mesenteric stripping using a Veress needle: A creative approach to resect small bowel disease in advanced ovarian cancer". Gynecol Oncol Rep 2023; 45:101111. [PMID: 36703706 PMCID: PMC9871054 DOI: 10.1016/j.gore.2022.101111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
Small bowel involvement in patients with advanced ovarian cancer has been associated with a worse prognosis and recent data suggests it can be an independent factor associated with shorter disease-free interval (Casales Campos et al., 2022). In the upfront cytoreductive setting, small bowel residual disease (serosa and mesentery) has been identified as the most common site of residual disease (Heitz et al., 2016). The morbidity associated with multiple small bowel resections and the length of the remaining small bowel constitute major limiting factors. As the surgical armamentarium of the gynecologic oncologist has considerably broaden to include more radical procedures, addressing miliary small bowel disease remains extremely important in the quest to achieve complete gross resection (CGR) and thus improving the overall prognosis (Jurado and Chiva, 2021). We present a case of a patient with stage IIIC high grade serous ovarian carcinoma that already had started neoadjuvant chemotherapy before presenting for surgical options. After 4 cycles of carboplatin and paclitaxel, the patient was offered interval cytoreductive surgery plus HIPEC with cisplatin. During surgical exploration, miliary small bowel mesenteric disease was noted but with a grossly intact jejunoileal serosa. The patient underwent bilateral diaphragmatic stripping, cholecystectomy, extraperitoneal hysterectomy and multiple parietal peritonectomies. A decision was made to perform a mesenterectomy using a Veress needle. A standard insuflator was utilized to a maximum pressure of 4 mmHg. CGR was achieved and the patient underwent HIPEC as per institution protocol. The post operative course was uneventful and the patient was discharged five days after surgery. She is currently free of disease (20 months after surgery).
Collapse
Affiliation(s)
- Joao Casanova
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Hospital da Luz Lisboa, Lisbon, Portugal
| | - José Filipe Cunha
- Digestive Surgery Unit, Champalimaud Clinical Center, Lisboa, Portugal
| | - Sara Proença
- Department of Obstetrics and Gynecology, Hospital de Cascais, Cascais, Portugal
| | - Dennis Chi
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, NY, USA
| |
Collapse
|
7
|
Nassar D, Shu M, Stevens R, Chen R, Eddib A. Renal Hilum Injury with Veress Needle. CRSLS 2022; 9:CRSLS.2022.00019. [PMID: 36816460 PMCID: PMC9903250 DOI: 10.4293/crsls.2022.00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Introduction Since the advent of laparoscopy, the ideal first-port entry technique has not yet been determined. Use of the Veress needle at Palmer's point, although safe in practice under skilled physicians, is not without risk of complications. Case Description A female patient with prior abdominal surgeries underwent a laparoscopic surgery for a nonmalignant indication. Intraoperative complications included hemodynamic instability and gross hematuria. The patient was ultimately stabilized, and imaging after the case revealed a hematoma formation around the left kidney with evidence of renal hilar injury. Discussion The laparoscopic surgeon must be aware that blind Veress needle entry has inherent risk for injury of retroperitoneal structures including the renal system. Particularly if hemodynamic instability is noted after abdominal entry at any site, physicians should have a low threshold for investigation, including by laparotomy if necessary.
Collapse
Affiliation(s)
| | - Michael Shu
- Department of Minimally Invasive Gynecologic Surgery, Kaleida Health Systems, Millard Fillmore Suburban Hospital, Williamsville, New York. (Drs. Shu, Stevens, and Eddib)
| | - Rebeccah Stevens
- Department of Obstetrics and Gynecology, University at Buffalo, The State University of New York, Buffalo, New York. (Drs. Nassar and Stevens and Ms. Chen),Department of Minimally Invasive Gynecologic Surgery, Kaleida Health Systems, Millard Fillmore Suburban Hospital, Williamsville, New York. (Drs. Shu, Stevens, and Eddib)
| | - Ruthia Chen
- Department of Obstetrics and Gynecology, University at Buffalo, The State University of New York, Buffalo, New York. (Drs. Nassar and Stevens and Ms. Chen)
| | - Abeer Eddib
- Department of Minimally Invasive Gynecologic Surgery, Kaleida Health Systems, Millard Fillmore Suburban Hospital, Williamsville, New York. (Drs. Shu, Stevens, and Eddib),Western New York Urology Associates, Cheektowaga, New York. (Dr. Eddib)
| |
Collapse
|
8
|
Onoda T, Sato M, Torii K, Inamori K, Okada E, Nozawa M, Shiiya N, Wada H. A negative pressure-based visualization technique for abdominal Veress needle insertion. Langenbecks Arch Surg 2022. [PMID: 35355106 DOI: 10.1007/s00423-022-02504-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Abdominal Veress needle insertion is commonly performed to generate a pneumoperitoneum during laparoscopy. Various safety tests are conducted to confirm accurate needle tip positioning into the abdominal cavity. However, these occasionally yield unclear results and do not help directly visualize the peritoneum puncture. We validated a negative pressure-based technique that helps instantly visualize the moment of the Veress needle entry into the abdominal cavity. METHODS This study included 761 patients who underwent laparoscopic hernioplasty between 2003 and 2021 that entailed pneumoperitoneum creation using a Veress needle. They were divided into conventional technique (CON) and negative pressure visualization technique (NPV) groups. The patients were propensity score-matched (1:1) to minimize selection bias. To determine whether the technique gave a clear result to the surgeon and precisely informed the moment of entry, failed entry and emphysematous complications were compared between the groups. RESULTS The propensity score-matching yielded 105 pairs in the matched CON and NPV groups. Failed entry did not occur in the NPV group, whereas it occurred in 8 patients (7.6%) in the CON group (p = 0.004). No patient experienced extraperitoneal emphysema in the matched NPV group, whereas 7 patients (6.7%) in the CON group did (p = 0.007). The groups did not differ in the incidence of omental or mesenteric emphysema. CONCLUSION The NPV eliminated the incidence of failed entry and decreased the incidence of extraperitoneal emphysema, indicating that it could simply and adequately inform the moment of needle entry into the abdominal cavity.
Collapse
|
9
|
Bianchi A, Collivignarelli F, Vignoli M, Scaletta L, Cuomo A, Falerno I, Paolini A, Tamburro R. A Comparison of Times Taken for the Placement of the First Portal and Complication Rates between the Veress Needle Technique and the Modified Hasson Technique in Canine Ovariectomy Laparoscopic Surgery. Animals (Basel) 2021; 11:2936. [PMID: 34679957 PMCID: PMC8532732 DOI: 10.3390/ani11102936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/22/2021] [Accepted: 10/06/2021] [Indexed: 11/26/2022] Open
Abstract
Minimally invasive surgery is increasingly being used in veterinary medicine. Laparoscopic procedures have several advantages compared with open surgery. These include the magnification of the field of surgery, reduced post-surgical pain and associated stress, reduced post-operative infection rates, and decreased hospitalization time. The establishment of a pneumoperitoneum is a critical step; however, this procedure can prolong the operation time, and most of the complications associated with laparoscopic surgery have been attributed to the insertion of devices into the abdominal cavity. Two main techniques have been employed to create pneumoperitoneum: the closed-entry method using the Veress needle and the open Hasson technique. The first portal is necessary to start insufflation and, subsequently, to realize the operative channel to insert the laparoscopic instruments into the abdomen. Many authors have compared the time necessary to create the first portal using different techniques in human medicine, but studies on this topic in veterinary medicine are lacking. In the veterinary medicine literature, complications associated with the creation of a pneumoperitoneum and the placement of ports include spleen, bowel, or bladder injuries; pneumothorax; and subcutaneous emphysema. The aim of the present study was to compare the times required for the placement of the first portal and the creation of pneumoperitoneum, and the rates of intraoperative complications using the Veress needle technique (VNT) and the open modified Hasson technique (MHT). The sample population comprised 30 female dogs who underwent laparoscopic ovariectomies. The dogs were randomly organized into two groups and two different entry techniques were used: Veress needle (VNT = group A) and the modified Hasson technique (MHT = group B). Complications related to abdominal entry were classified as major, in cases of organ perforation, and minor, in cases of subcutaneous emphysema and gas leakage. The VNT and MHT required 374.0 s and 242.9 s, respectively, for the placement of the first portal and for establishing pneumoperitoneum (p < 0.05). Their major complications rates were 20% and 0%, respectively (p < 0.05). Their minor complications rates were 20% and 35%, respectively (p < 0.05). No surgical procedures required laparotomy. The MHT was associated with a lower major complication rate and required less time to create the first portal, compared with the Veress needle technique.
Collapse
Affiliation(s)
- Amanda Bianchi
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (F.C.); (A.C.); (I.F.); (A.P.); (R.T.)
| | - Francesco Collivignarelli
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (F.C.); (A.C.); (I.F.); (A.P.); (R.T.)
| | - Massimo Vignoli
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (F.C.); (A.C.); (I.F.); (A.P.); (R.T.)
| | - Lorenzo Scaletta
- Veterinaria Enterprise Stp S.R.L., Via Galvani 33d, 00153 Rome, Italy;
| | - Amedeo Cuomo
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (F.C.); (A.C.); (I.F.); (A.P.); (R.T.)
| | - Ilaria Falerno
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (F.C.); (A.C.); (I.F.); (A.P.); (R.T.)
| | - Andrea Paolini
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (F.C.); (A.C.); (I.F.); (A.P.); (R.T.)
| | - Roberto Tamburro
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy; (F.C.); (A.C.); (I.F.); (A.P.); (R.T.)
| |
Collapse
|
10
|
Postema RR, Cefai D, van Straten B, Miedema R, Hardjo LL, Dankelman J, Nickel F, Horeman-Franse T. A novel Veress needle mechanism that reduces overshooting after puncturing the abdominal wall. Surg Endosc 2021; 35:5857-5866. [PMID: 34159463 PMCID: PMC8437840 DOI: 10.1007/s00464-021-08603-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Complications that occur in laparoscopic surgery are often associated with the initial entry into the peritoneal cavity. The literature reported incidences of Veress needle (VN) injuries of e.g. 0.31% and 0.23%. In a 2010 national survey of laparoscopic entry techniques in the Canadian General Surgical practice, 57.3% of respondents had either experienced or witnessed a serious laparoscopic entry complication like bowel perforation and vascular injury. As those complications are potentially life threatening and should be avoided at all costs, improving safety of this initial action is paramount. METHODS Based on a bare minimum design approach with focus on function expansion of existing components, a new Safety mechanism was developed for the VN that decreases the risks of VN overshooting. The mechanism works by preventing the puncturing acceleration of the tip of the VN by decoupling the surgeon's hand from the VN immediately after entering the abdomen. RESULTS Based on a set of requirements, a first prototype of the VN+ with force decoupling safety mechanism is presented and evaluated on an ex vivo porcine abdominal wall tissue model in a custom setup. The experiments conducted by two novices and one experienced surgeon indicated a significant difference between the attempts with a standard, conventional working VN (41.4 mm [37.5-45 mm]) and VN+ with decoupling mechanism (20.8 mm [17.5-22.5 mm]) of p < 0.001. CONCLUSION A new decoupling safety mechanism was integrated successfully in a standard VN resulting in a VN+ . The results from the pilot study indicate that this new VN+ reduces overshooting with a minimum of 50% in a standardised ex vivo setting on fresh porcine abdominal wall specimens.
Collapse
Affiliation(s)
- Roelf R Postema
- Department of BioMechanical Engineering, Faculty of Biomedical Engineering, University of Technology Delft, Mekelweg 2, 2628 CD, Delft, The Netherlands
- Department of Surgery, University Medical Centers Amsterdam, Location VUMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - David Cefai
- Engineering Department, ProVinci Medtech, 2631 CM, Nootdorp, The Netherlands
| | - Bart van Straten
- Department of BioMechanical Engineering, Faculty of Biomedical Engineering, University of Technology Delft, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - Rein Miedema
- Department of BioMechanical Engineering, Faculty of Biomedical Engineering, University of Technology Delft, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - Latifa Lesmana Hardjo
- Department of BioMechanical Engineering, Faculty of Biomedical Engineering, University of Technology Delft, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - Jenny Dankelman
- Department of BioMechanical Engineering, Faculty of Biomedical Engineering, University of Technology Delft, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Tim Horeman-Franse
- Department of BioMechanical Engineering, Faculty of Biomedical Engineering, University of Technology Delft, Mekelweg 2, 2628 CD, Delft, The Netherlands.
| |
Collapse
|
11
|
Dogra PM, Nair RK, Sood V, Datt B, Katyal A, Jairam A, Hooda A, Mendonca S, Mukherjee D, Chauhan P, Murari T. Pneumoperitoneum needle vs. introducer needle: Comparison of complications and short-term outcomes in percutaneously inserted peritoneal dialysis catheters in naïve abdomens. Ther Apher Dial 2021; 26:212-219. [PMID: 33998155 DOI: 10.1111/1744-9987.13688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/29/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022]
Abstract
Percutaneous peritoneal dialysis catheter (PDC) insertion for continuous ambulatory peritoneal dialysis (CAPD) entails a higher risk of complications such as bowel injury, vascular injury, and catheter migration compared to the surgical insertions. We conducted a comparative analysis of two techniques of peritoneal entry for PDC insertion by Seldinger technique. We performed a retrospective review of 426 percutaneously inserted PDCs in nonobese naïve abdomens for CAPD at two tertiary care teaching hospitals in India over 6 years. Comparison of various mechanical complications, and short-term catheter survival was done between use of introducer needle (Group "I") and spring-loaded pneumoperitoneum (Veress) needle (Group "V"). Group "I" to "V" patient ratio was 277:149. Group "I" had heavier patients (p = 0.03) whereas "V" group had a dominance of diabetes (p = 0.009) and prior hemodialysis patients (p = 0.03). At 3 months, the odds of mechanical complications (OR = 0.27, p = 0.004), PDC migration (OR = 0.18, p = 0.02), and omental wrapping (OR = 0.13, p = 0.04) were less in "V" group. No bowel injury occurred with Veress needle use. At 6 months, "V" group had higher odds of event-free sustained PDC tip position (OR = 0.39, p = 0.003), and catheter survival (p = 0.03), and the cumulative events were lesser too (p = 0.002). Refractory peritonitis and deaths with functioning catheter were comparable between both the groups. In this first-of-its-kind study, spring-loaded Veress pneumoperitoneum needle use was safer, entrusted sustained PDC tip position in pelvis, and had a better catheter survival compared to use of introducer needle for peritoneal entry in percutaneously inserted PDCs. These findings should be confirmed by a randomized controlled study.
Collapse
Affiliation(s)
| | - Ranjith K Nair
- Department of Nephrology, Army Hospital (R&R), New Delhi, India
| | - Vivek Sood
- Department of Nephrology, Army Hospital (R&R), New Delhi, India
| | - Bhaskar Datt
- Department of Nephrology, Army Hospital (R&R), New Delhi, India
| | - Amit Katyal
- Department of Nephrology, Army Hospital (R&R), New Delhi, India
| | | | - Ashok Hooda
- Department of Nephrology, Army Hospital (R&R), New Delhi, India
| | - Satish Mendonca
- Department of Nephrology, Army Hospital (R&R), New Delhi, India
| | | | | | - Tomala Murari
- Department of Nephrology, Military Hospital, Jalandhar, India
| |
Collapse
|
12
|
Di Vece C, Luciano C, De Momi E. Psychomotor skills development for Veress needle placement using a virtual reality and haptics-based simulator. Int J Comput Assist Radiol Surg 2021; 16:639-47. [PMID: 33709241 DOI: 10.1007/s11548-021-02341-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 01/07/2021] [Indexed: 11/04/2022]
Abstract
Purpose Veress needle (VN) insertion, if not correctly performed, could cause severe injuries to intra-abdominal organs and vessels. Therefore, cognitive and psychomotor skills training is needed. Virtual reality (VR) and haptic technologies have the potential to offer realistic simulations. Methods We developed a novel VR and haptic surgical simulator for VN insertion to teach trainees how to correctly puncture the abdominal wall, experiencing realistic tactile sensations throughout the simulation. The simulator allows for both procedural and realistic training. We released two different versions: the first using the OpenHaptics\documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$^{\text {TM}}$$\end{document}TM (OH) Toolkit and the second exploiting CHAI3D. We evaluated the learning effect using different performance indexes (time to perform the procedure, error in insertion angle, number of undesired contacts with organs) in an insertion task for both experienced urologists and students. Results A general improvement of the chosen performance indexes was registered in the second repetition of the task for both groups. From the questionnaires, the simulator leveraging OH provides the trainee with a more precise haptic feedback, whereas the one exploiting CHAI3D allows them to perform the procedure more easily thanks to the better visualization of the virtual environment. The results proved that the participants appreciated both implementations, and the System Usability Scale (SUS) test resulted in a “good” usability. Conclusion The haptics-based and VR simulator has shown the potential to be an important resource for the basic urological training in obtaining the pneumoperitoneum and improving the acquisition of the necessary psychomotor skills, allowing for extended and more effective training without compromising patient safety.
Collapse
|
13
|
Pini Prato A, Palo F, Faticato MG, Carlini C, Mattioli G. Safety of Veress needle for laparoscopic entry in children: Myth or reality? J Pediatr Surg 2021; 56:569-72. [PMID: 32624202 DOI: 10.1016/j.jpedsurg.2020.05.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/15/2020] [Accepted: 05/30/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Recent reports suggested that blind laparoscopic entry techniques, including Veress needle (VN), might increase the risks of potentially fatal complications. MATERIALS AND METHODS All consecutive patients who underwent laparoscopy in two Pediatric Hospitals with the use of a Veress needle during a 14-year period have been included. In all cases the first trocar was a radially expanding one (STEP). Complications related to the insertion technique are reported as well as those related to the whole laparoscopic technique. RESULTS A total of 3463 patients younger than 18 years of age underwent laparoscopy between January 2006 and December 2019. Of these, 205 (5.9%) were younger than 6 months of age at surgery. Two-hundred-eighty-four patients (8.2%) previously underwent abdominal surgery. During first trocar insertion no major or minor vascular injuries occurred. Two patients (0.06%) experienced bowel lesions. Nine (0.26%) experienced failed entry. Fourteen patients (0.4%) experienced postoperative issues related to trocars positioning, namely, 9 omental eviscerations through port site insertion and 5 cases of hemoperitoneum owing to epigastric vessels lesion during operative trocar positioning. No other issues strictly related to laparoscopic entry technique have been recorded during the study period. No specific risk factors predisposing to complications have been identified but the presence of a positive history of previous abdominal procedures proved to be significantly related to a higher occurrence of bowel injury during Veress needle insertion (p = 0.0067). DISCUSSION AND CONCLUSIONS Although with a number of biases and limitations, our study suggests that creation of pneumoperitoneum with VN combined to first trocar entry with STEP technology in children can represent a safe alternative. An exception is represented by patients who underwent previous abdominal surgeries who should be approached with caution, possibly with an open approach. Anyway, given the relatively poor quality of high-quality studies on this regard, we strongly support the implementation of well-designed RCT in children in order to answer this delicate topic. TYPE OF STUDY Retrospective. LEVEL OF EVIDENCE IV.
Collapse
|
14
|
Brenner-Anidjar RD, Rojo-Novo S, Frías-Sánchez Z, Montaño-Serrano M, Pantoja-Rosso FJ, Terracina D, Pantoja-Garrido M. Palmer's test usefulness in the correct positioning of the Veress needle and the reduction of complications during laparoscopic access maneuvers. J Obstet Gynaecol Res 2021; 47:576-582. [PMID: 33118305 DOI: 10.1111/jog.14544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/31/2020] [Accepted: 10/18/2020] [Indexed: 11/28/2022]
Abstract
AIM Abdominal cavity access accounts for 50% of complications during laparoscopic surgery. Different safety maneuvers have been used to try to diminish these. Our study aims to establish the usefulness of Palmer's test in the correct positioning of the Veress needle and the reduction of complications during laparoscopic access maneuvers, when used in addition to the determination of intraabdominal pressure. METHODS Prospective observational analytic multi-centered cohort study with 370 patients undergoing gynecologic laparoscopy between July 2014 and November 2019, comparing the additional use of Palmer's test in 185 patients (Palmer-Test-Yes, PTY), with intraabdominal pressure determination alone in 185 patients (Palmer-Test-No, PTN). RESULTS Intergroup homogeneity was described for the basic characteristics of both population samples, except for mean age and percentage of previous laparotomy. A total of 19 complications were recorded, 10 in PTY and 9 in PTN, with no significant differences (P = 0.814). No differences were found in the analysis of these complications, except for the rate of conversion to laparotomy, which occurred four times in the PTY group and none in PTN (P = 0.044). Furthermore, no differences were found once fixed for the history of previous laparotomy (P = 514.), nor for the percentage of successful access after the first attempt between both groups (P = 0.753). CONCLUSION Palmer's test, when used in addition to intraabdominal pressure determination, has not shown to be effective in preventing failed access to abdominal cavity or reducing complications associated with access maneuvers with the Veress needle. Hence, its systematic use is not justified, since it could generate a sense of false security.
Collapse
Affiliation(s)
| | - Sara Rojo-Novo
- Gynecology and Obstetrics, Virgen Macarena University Hospital, Seville, Spain
| | - Zoraida Frías-Sánchez
- Gynecology and Breast Pathology Unit, Virgen del Rocio University Hospital, Seville, Spain
| | - María Montaño-Serrano
- Gynecology and Obstetrics Unit, Hospitalet Hospital and Quiron Salud-Barcelona Hospital, Autonoma University of Barcelona, UAB, Barcelona, Spain
| | | | - Dan Terracina
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | |
Collapse
|
15
|
Reynolds RE, Wankum BP, Crimmins SJ, Carlson MA, Terry BS. Preperitoneal insufflation pressure of the abdominal wall in a porcine model. Surg Endosc 2021; 36:300-306. [PMID: 33481111 DOI: 10.1007/s00464-020-08275-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/24/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Most complications and adverse events during laparoscopic surgery occur during initial entry into the peritoneal cavity. Among them, preperitoneal insufflation occurs when the insufflation needle is incorrectly placed, and the abdominal wall is insufflated. The objective of this study was to find a range for static pressure which is low enough to allow placement of a Veress needle into the peritoneal space without causing preperitoneal insufflation, yet high enough to separate abdominal viscera from the parietal peritoneum. METHODS A pressure test was performed on twelve fresh porcine carcasses to determine the minimum preperitoneal insufflation pressure and the minimum initial peritoneal cavity insufflation pressure. Each porcine model had five needle placement categories. One category tested the initial peritoneal cavity insufflation pressure beneath the umbilicus. The four remaining categories tested the preperitoneal insufflation pressure at four different anatomical locations on the abdomen that can be used for initial entry. The minimum initial insufflation pressures from each carcass were then compared to the preperitoneal insufflation pressures to obtain an optimal range for initial insufflation. RESULTS Increasing the insufflation pressure increased the probability of preperitoneal insufflation. Also, there was a statistically significant difference (p < 0.05) between the initial peritoneal cavity insufflation pressures (8.83 ± 4.19 mmHg) and the lowest preperitoneal pressures (32.54 ± 7.84 mmHg) (mean ± SD). CONCLUSION Pressures greater than 10 mmHg resulted in initial cavity insufflation and pressures greater than 20 mmHg resulted in preperitoneal insufflation in porcine models. By knowing the minimum pressure required to separate the layers of the abdominal wall, the risk of preperitoneal insufflation can be mitigated while obtaining safe and efficient entry into the peritoneal cavity. The findings in this research are not a guideline for trocar or Veress needle placement, but instead reveal preliminary data which may lead to more studies, technology, etc.
Collapse
Affiliation(s)
- Riley E Reynolds
- Department of Mechanical Engineering, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA
| | - Benjamin P Wankum
- Department of Mechanical Engineering, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA.
| | - Sean J Crimmins
- Department of Mechanical Engineering, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA
| | - Mark A Carlson
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Benjamin S Terry
- Department of Mechanical Engineering, University of Nebraska-Lincoln, Lincoln, NE, 68588, USA
| |
Collapse
|
16
|
Ikechebelu JI, Eleje GU, Joe-Ikechebelu NN, Okafor CD, Okpala BC, Ugwu EO, Nwachukwu CE, Okoro CC, Okam PC. Randomized control trial on effectiveness and safety of direct trocar versus Veress needle entry techniques in obese women during diagnostic laparoscopy. Arch Gynecol Obstet 2021; 304:815-22. [PMID: 33417065 DOI: 10.1007/s00404-020-05957-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine the benefits and safety of direct trocar insertion versus Veress needle technique in obese women undertaking diagnostic laparoscopy procedures. METHODS Randomized-controlled trial on 135 obese women undergoing diagnostic laparoscopy and dye test for infertility was conducted. Women were randomly assigned to either direct trocar access (n = 68) or Veress needle access (n = 67) before achieving pneumoperitoneum. The same surgeon executed the laparoscopic techniques with a single-puncture technique. The primary outcome measures included total length of the procedure and incidence of any complications, while the mean laparoscopic entry time, volume of CO2 required, and total of tries needed to attain successful entry were secondary outcomes. Intention-to-treat principle was applied to analysis. RESULTS Women in both groups had similar socio-demographic and clinical characteristics and none were lost to follow-up. The overall length of the procedure was significantly lesser in the direct trocar group compared to the Veress needle group (9.9 ± 6.0 vs 16.7 ± 4.7 min; p < 0.001). No significant differences occurred in other outcomes including mean entry time, volume of CO2 used, number of attempts for successful entry, and major/minor complications (p > 0.05). CONCLUSIONS Direct trocar technique may be an effective alternative to Veress needle for pneumoperitoneum in obese women for diagnostic laparoscopy. It has a comparable rapid laparoscopic entry time but a significantly lower duration of the procedure and shorter exposure to anesthesia. Both methods are equally effective as there was no significant difference in the complications recorded. A greater sample trial may be essential for more corroborative substantiation. CLINICAL TRIAL REGISTRATION PACTR201510000999192.
Collapse
|
17
|
Udwadia TE. Method for safe Verres needle entry at the umbilicus, with modification for first trocar entry to reduce the complication rate of first entry. J Minim Access Surg 2021; 17:329-336. [PMID: 33885028 PMCID: PMC8270035 DOI: 10.4103/jmas.jmas_235_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Initial intraperitoneal access and first trocar entry are responsible for nearly half of all complications of laparoscopic surgery. The purpose of this article is to detail our method of initial intraperitoneal access with Veress needle and first trocar at the umbilicus used over the past 28 years. Patients and Methods Since 1990, a single surgeon performed laparoscopic surgery in 7600 patients. From 1992 onward, 6975 patients underwent laparoscopic surgery. On assessment, 739 cases (10.6%) were found unsuitable for Veress needle entry at the umbilicus. The remaining, 6236, patients form the study group for this article. Every patient was operated in the identical, repetitive manner. Every detail was considered important. The method of the first trocar entry is modified to minimise complications of this manoeuvre. Results The average time from cleaning umbilicus again to Veress needle tip in peritoneum was 1 min 40 s (25 s-7 min). Out of the 4228 patients in whom no adhesions were observed at first trocar entry (Group 1), the Veress needle insertion was successful at first attempt in 3829 (90.5%) patients, at second attempt in 322 (7.6%) and at third attempt in 30 (0.7%). In the 2008 patients with significant adhesions observed after first trocar entry (Group 2), successful insertion of the Veress needle was achieved at first attempt in 1700 (84.6%) patients, at second attempt in 182 (9%) and at third attempt in 19 (0.9%). In this group, there was one bowel injury (0.05%) and 3 (0.15%) minor vascular injuries. There was no mortality in either group. In the overall series, the Veress needle was successfully introduced in 6082 of the 6236 patients (97.5%) and 154 patients (2.4%) failed Veress needle entry. The incidence of bowel injury in the series was 0.016% and that of minor vascular injuries was 0.048%. Conclusions Initial intraperitoneal access must be performed with utmost caution after adequate training and proctorship. This paper stresses with meticulous attention to every detail, this safe, method of initial intraperitoneal access leads to low complication rates.
Collapse
Affiliation(s)
- Tehemton Erach Udwadia
- Department of Surgery, Grant Medical College and J. J. Hospital; Breach Candy Hospital and Medical Research Centre; Department of Surgery, B. D. Petit Parsee General Hospital; Department of Minimal Access Surgery, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| |
Collapse
|
18
|
Vilos GA, Ternamian A, Laberge PY, Vilos AG, Abu-Rafea B, Scattolon S, Leyland N. Guideline No. 412: Laparoscopic Entry for Gynaecological Surgery. J Obstet Gynaecol Can 2020; 43:376-389.e1. [PMID: 33373697 DOI: 10.1016/j.jogc.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the benefits and risks of laparoscopic surgery and provide clinical direction on entry techniques, technologies, and their associated complications in gynaecological surgery. TARGET POPULATION All patients, including pregnant women and women with obesity, undergoing laparoscopic surgery for various gynaecological indications. OPTIONS The laparoscopic entry techniques and technologies reviewed in formulating this guideline included the closed (Veress needle-pneumoperitoneum-trocar) technique, direct trocar insertion, open (Hasson) technique, visual entry systems, and disposable shielded and radially expanding trocars. OUTCOMES Implementation of this guideline should optimize decision-making in the selection of entry technique for laparoscopic surgery. EVIDENCE We searched English-language articles from September 2005 to December 2019 in PubMed/MEDLINE, Embase, Science Direct, Scopus, and Cochrane Library using the following MeSH search terms alone or in combination: laparoscopic entry, laparoscopy access, pneumoperitoneum, Veress needle, open (Hasson), direct trocar, visual entry, shielded trocars, radially expanded trocars, and laparoscopic complications. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Canadian Task Force on Preventive Health Care approach (Appendix A). INTENDED AUDIENCE Surgeons performing laparoscopic gynaecological surgery. SUMMARY STATEMENTS RECOMMENDATIONS.
Collapse
|
19
|
Maeda H, Kajiwara K, Yoshimatsu R, Yamanishi T, Minamiguchi H, Karashima T, Inoue K, Awai K, Yamagami T. Artificially induced pneumothorax with a Veress needle for cryoablation of renal cell carcinoma. MINIM INVASIV THER 2020; 31:483-486. [PMID: 32903048 DOI: 10.1080/13645706.2020.1814341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Thermal ablative techniques are used increasingly to treat renal cell carcinoma (RCC). Percutaneous cryoablation of tumors at the upper pole of the kidney may result in pulmonary damage due to the intervening lung parenchyma. We treated two patients with RCC in the upper pole of the kidney by inducing pneumothorax with a pneumoperitoneum needle before proceeding to percutaneous cryoablation. The procedures, performed under computed tomography (CT) fluoroscopy guidance, resulted in complete tumor necrosis. There was no pulmonary damage.
Collapse
Affiliation(s)
- Hitomi Maeda
- Radiology, Medical School, Kochi University, Kochi, Japan
| | - Kenji Kajiwara
- Radiology, Medical School, Kochi University, Kochi, Japan
| | | | | | | | | | - Keiji Inoue
- Urology, Medical School, Kochi University, Kochi, Japan
| | - Kazuo Awai
- Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | |
Collapse
|
20
|
Daemen JHT, Deden LN, van den Ende A, Pijl MEJ, Slump CH, Berends FJ, Aarts EO. A novel abdominal wall entry suction device to increase Veress needle safety: A prospective cohort pilot study. Ann Med Surg (Lond) 2019; 47:70-74. [PMID: 31645941 PMCID: PMC6804323 DOI: 10.1016/j.amsu.2019.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/24/2019] [Accepted: 10/02/2019] [Indexed: 11/24/2022] Open
Abstract
Background In laparoscopic surgery, the Veress needle technique is most often used to initiate a pneumoperitoneum. Although low, entry-related injuries of the intestines and major vascular structures occur in 0.04–0.1% of cases. Up to 50% of these injuries remain undiagnosed at the time of surgery, resulting in mortality rates between 2.5 and 30%. In an effort to minimize such injuries we objectively assessed a novel abdominal wall entry suction device (AWESD) that was hypothesized to lift the abdominal wall and create an additional post-peritoneum safe margin for safer Veress needle introduction. Materials and methods A prospective pilot study was conducted in which CT-scans with and without AWESD application (centered above the umbilicus) were assessed to determine its effect on the distance from the linea alba to the intestines, vena cava and abdominal aorta. Paired measurements were subjected to the Wilcoxon signed rank test. Results Twelve participants were included. The AWESD significantly increased the median distance towards the intestines in the axial and sagittal plane (P = 0.01 and P = 0.006) from 0.93 (Inter Quartile Range (IQR): 0.33–1.51) and 0.85 (IQR: 0.32–1.47) to 1.35 (IQR: 0.39–2.27) and 1.25 (IQR: 0.42–2.10) centimeters, respectively. Similarly, for the median axial distances towards the vena cava and abdominal aorta (both P = 0.002) that were increased from 10.00 (IQR: 7.18–11.12) and 9.33 (IQR: 6.55–10.28) to 13.23 (IQR: 11.76–14.31) and 12.49 (IQR: 10.98–13.32) centimeters, respectively. Conclusion The AWESD significantly increased the distances between the peritoneum and main intra-abdominal structures. However, conclusions on subsequent increased safety cannot be drawn as high-volume studies are required to determine its clinical relevance. Veress needle related injuries are rare but associated with high mortality rates. A novel abdominal entry suction device to increase Veress needle safety was studied. The device increased the distance between peritoneum and intra-abdominal structures. The increased distance was greatest for the vena cava and abdominal aorta. Despite the increased distances, the devices' clinical relevance remains unknown.
Collapse
Affiliation(s)
- Jean H T Daemen
- Department of Surgery, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Laura N Deden
- Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | | | - Milan E J Pijl
- Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Cornelis H Slump
- Department of Robotics and Mechatronics, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Frits J Berends
- Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| | - Edo O Aarts
- Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands
| |
Collapse
|
21
|
Abstract
OBJECTIVE To provide clinical direction, based on the best evidence available, on laparoscopic entry techniques and technologies and their associated complications. OPTIONS The laparoscopic entry techniques and technologies reviewed in formulating this guideline include the classic pneumoperitoneum (Veress/trocar), the open (Hasson), the direct trocar insertion, the use of disposable shielded trocars, radially expanding trocars, and visual entry systems. OUTCOMES Implementation of this guideline should optimize the decision-making process in choosing a particular technique to enter the abdomen during laparoscopy. EVIDENCE English-language articles from Medline, PubMed, and the Cochrane Database published before the end of September 2005 were searched, using the key words laparoscopic entry, laparoscopy access, pneumoperitoneum, Veress needle, open (Hasson), direct trocar, visual entry, shielded trocars, radially expanded trocars, and laparoscopic complications. VALUES The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on the Periodic Health Examination. RECOMMENDATIONS AND SUMMARY STATEMENT.
Collapse
|
22
|
Pantoja Garrido M, Frías Sánchez Z, Zapardiel Gutiérrez I, Torrejón R, Jiménez Sánchez C, Polo Velasco A, Márquez Maraver F, Rodríguez Jiménez I, Jiménez Gallardo J, Fernández Alba JJ. Direct trocar insertion without previous pneumoperitoneum versus insertion after insufflation with Veress needle in laparoscopic gynecological surgery: a prospective cohort study. J OBSTET GYNAECOL 2019; 39:1000-1005. [PMID: 31210067 DOI: 10.1080/01443615.2019.1590804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of this study was to determine whether direct trocar entry without prior pneumoperitoneum at umbilical level (DTI) can be a safe alternative to access the abdominal cavity in gynaecological laparoscopic surgery. We present a prospective observational analytical study of cohorts, comparing DTI with umbilical entry with trocar after previous insufflation with a Veress needle at umbilical level (V). The study period was performed from June 2013 to April 2016; data was collected on 600 patients who underwent gynaecological laparoscopic surgery. There were no significant differences in the risk of suffering a complication during the access manoeuvres between DTI (6.49%) and V (7.39%), OR 0.89 (95% CI: 0.42-1.81). The duration of the access manoeuvres was 69 s in DTI and 193 s in V (p < .001). The percentage of patients in whom two or more access attempts were performed was lower in DTI (7.8%) than in V (12.3%) (p > .05). We concluded that DTI is at least as safe as V, regarding the risk of suffering complications arising from access into the abdominal cavity. DTI has advantages with regard to V, such as: the shorter duration of access manoeuvres or the lesser number of unsuccessful entry or insufflation attempts. Impact statement What is already known on this subject? There are few international publications comparing DTI and V. When we conducted a search in PubMed for the terms 'Veress needle and direct trocar insertion', 51 publications were obtained. When we increased the restriction and added the terms 'laparoscopic entry and laparoscopy complications', 27 publications were obtained; thus, the uniqueness of our study. What do the results of this study add? We present a 3-year observational prospective study of cohorts that included 600 patients. The aim of this study was to determine that in laparoscopic gynaecological surgery, DTI is an access method to the abdominal cavity at least as safe as V, with respect to the risk of complications. On the other hand, DTI has some advantages such as the shorter duration of access manoeuvres or the lower number of failed entry attempts. What are the implications of these findings for clinical practice and/or further research? Given the limited number of publications that compared both techniques, our study indicates that DTI can be a safe alternative for access to abdominal cavity in gynaecological surgery, compared to the traditional V.
Collapse
Affiliation(s)
- Manuel Pantoja Garrido
- Department of Gynecology and Obstetrics, University Hospital Virgen Macarena , Seville , Spain
| | - Zoraida Frías Sánchez
- Department of Gynecology and Obstetrics, University Hospital Virgen del Rocío , Seville , Spain
| | | | - Rafael Torrejón
- Department of Gynecology and Obstetrics, University Hospital Puerta del Mar , Cádiz , Spain
| | | | - Alfredo Polo Velasco
- Department of Gynecology and Obstetrics, University Hospital Virgen Macarena , Seville , Spain
| | | | | | - Julián Jiménez Gallardo
- Department of Gynecology and Obstetrics, University Hospital Virgen Macarena , Seville , Spain
| | | |
Collapse
|
23
|
Wolthuis AM. Veress Needle Creation of a Pneumoperitoneum: Is It Risky? Results of the First Belgian Group for Endoscopic Surgery-Snapshot Study. J Laparoendosc Adv Surg Tech A 2019; 29:1023-1026. [PMID: 31140894 DOI: 10.1089/lap.2019.0243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Every laparoscopic procedure starts with the creation of a pneumoperitoneum. The open trocar introduction and the use of a Veress needle (VN) are the two most frequent techniques used. The aim of this study was to evaluate safety of the techniques used to create pneumoperitoneum in laparoscopic abdominal surgery by Belgian minimally invasive surgeons. Materials and Methods: This is a prospective study including all consecutive patients undergoing a laparoscopic surgical procedure for a 2-month period. Primary endpoint was access-related problems during creation of a pneumoperitoneum. Access-related problems were registered using a special smartphone application, facilitating data recording and patient registration. Results: Overall, 9 out of 212 invited surgeons (4.2%) actively registered patients during the study period. A total number of 342 patients were included with 6 access-related problems (1.8%) and conversion to open surgery was necessary in 16 patients (4.7%). Most reported access-related problem was failure to establish a pneumoperitoneum secondary to insufflation of the omentum. There were no major access-related complications. There was no conversion in the group of patients who had an access-related problem. Conclusion: VN entry to create a pneumoperitoneum is safe. In a short study period, gathering data by surgeons willing to participate in a snapshot study is easy and facilitated by a web-based application.
Collapse
Affiliation(s)
- Albert M Wolthuis
- Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| |
Collapse
|
24
|
Mikhail E, Tamhane N, Sarkar P, Sappenfield E, Tanner JP, Imudia AN. Laparoscopic Entry Technique Using a Veress Needle Insertion with and without Concomitant CO 2 Insufflation: A Randomized Controlled Trial. J Minim Invasive Gynecol 2019; 26:1383-1388. [PMID: 30802609 DOI: 10.1016/j.jmig.2019.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/01/2019] [Accepted: 02/19/2019] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To compare the time and number of attempts needed for successful Veress needle entry during laparoscopic surgery using concomitant versus subsequent CO2 insufflation approaches. DESIGN Randomized controlled trial. SETTING University teaching hospital. PATIENTS One hundred consecutive patients scheduled for laparoscopic surgery by 2 high-volume laparoscopic surgeons were screened and randomized, and 95 of these were included in the final analysis. Ninety (45 in each group) was the precalculated priori number of patients needed to detect a 50% difference in the time (seconds) to obtain adequate insufflation with 90% power and alpha of 5%. INTERVENTIONS Patients were randomized to either Veress needle entry with concomitant (Con) or subsequent (Sub) CO2 insufflation. MEASUREMENTS AND MAIN RESULTS Forty-six patients were randomized to the Con group and 49 to the Sub group. Patient age, body mass index, prior surgical history, presence of adhesions, and type of procedure performed were similar between both groups. The median time required for adequate insufflation in the Con group was 103.5 seconds (Q1-Q3, 80.0-130.0) compared with 113.0 seconds (Q1-Q3, 102.0-144.0) in Sub group (p = .16). Approximately 89% (95% confidence interval, 80.1%-98.1%) of patients in Con group achieved successful entry in the first attempt compared with only 67% (95% confidence interval, 54.2%-80.0%) in Sub group (p = .01). The incidence of preperitoneal insufflation and failed entry was comparable between the 2 groups. No patient developed solid organ, visceral, or vascular injuries; gas embolism; or case conversion to laparotomy in relation to the Veress needle entry technique. CONCLUSION Veress needle entry with concomitant CO2 insufflation was associated with a higher rate of successful entry during the first attempt of Veress needle insertion. The total time required for insufflation and rates of complications between the 2 techniques were similar.
Collapse
Affiliation(s)
- Emad Mikhail
- Department of Obstetrics and Gynecology (Drs. Mikhail, Tamhane, Sarkar, and Imudia), University of South Florida, Morsani College of Medicine, Tampa, Florida.
| | - Nupur Tamhane
- Department of Obstetrics and Gynecology (Drs. Mikhail, Tamhane, Sarkar, and Imudia), University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Papri Sarkar
- Department of Obstetrics and Gynecology (Drs. Mikhail, Tamhane, Sarkar, and Imudia), University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Elisabeth Sappenfield
- Department of Obstetrics and Gynecology (Dr. Sappenfield), Hartford Hospital, Hartford, Connecticut
| | - Jean Paul Tanner
- Department of Community and Family Health (Dr. Tanner), College of Public Health, University of South Florida, Tampa, Florida
| | - Anthony N Imudia
- Department of Obstetrics and Gynecology (Drs. Mikhail, Tamhane, Sarkar, and Imudia), University of South Florida, Morsani College of Medicine, Tampa, Florida
| |
Collapse
|
25
|
Evsen MS, Icen MS, Findik FM, Tunc SY, Ağaçayak E, Gul T. A new technique in laparoscopic abdominal access (Evsen Method, Modified Veress Technique). Ginekol Pol 2018; 89:481-484. [PMID: 30318574 DOI: 10.5603/gp.a2018.0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/19/2018] [Accepted: 09/05/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The most important step in laparoscopic surgery is to safely establish the pneumoperitoneum, especially since approximately half of the complications occur during the initial entry into the abdomen. There is a distinct need to modify the available methods to reduce therate of adverse events in laparoscopic entry. In this study, a modified Veress technique (MVT) or Evsen method is introduced.The aim of this article was to present a modified Veress technique for establishing the pneumoperitoneum. MATERIAL AND METHODS The study was conducted at the Dicle University, Faculty of Medicine, Department of Obstetrics and Gynecology, from September 2016 to May 2017. A new laparoscopic entry technique was introduced and compared with the classical Veress technique. A total of 40 cases were included in the study. MVT and the classical Veress method were applied to 26 and 14 patients, respectively. RESULTS The pneumoperitoneum was established at the first attempt in 23 (88.5%) MVT patients and in 7 (50%) patients from the classical Veress method group. The number of insufflation attempts to establish a successful pneumoperitoneum was lower using MVT and the difference was statistically significant (p: 0.022). As far as time is concerned, a comparison between the groups revealed that the pneumoperitoneum was established in a statistically significantly shorter time using MVT (p < 0.00). CONCLUSIONS The modified Veress technique proved to be superior to the classical Veress method for establishing the pneumoperitoneum. Using the new method, the pneumoperitoneum was established after fewer attempts and in a shorter time.
Collapse
|
26
|
Cassata G, Palumbo V, Cicero L, De Luca A, Damiano G, Fazzotta S, Buscemi S, Lo Monte AI. OneShot-M: A New Device for Close Laparoscopy Pneumoperitoneum. Surg Innov 2018; 25:570-577. [PMID: 30196768 DOI: 10.1177/1553350618799542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The induction of pneumoperitoneum is the first and most critical phase of laparoscopy, due to the significant risk of serious vascular and visceral complications. The closed technique for the creation of pneumoperitoneum could lead to several surgical complications. The present study aimed to overcome the complications associated with the insertion of Veress needle, improving its use, and facilitating the rapid creation of pneumoperitoneum. METHODS Thirty large white female pigs were enrolled in our study. A common plunger was modified in order to allow the passage of a 15-cm long Veress needle. This method was applied to 26 laparoscopic procedures (26 pigs) of several specialist branches. RESULTS OneShot-M close laparoscopy pneumoperitoneum creation device allowed us to obtain pneumoperitoneum quickly in all attempts, without any intraoperative and postoperative complications related to the use of the Veress needle. CONCLUSION The use of the proposed device showed an induction time as quick as the standard laparoscopic closed abdominal entry. The patented device is cheap and allows a safe abdominal entry. In addition, abdominal entry is much faster than the classic open technique.
Collapse
Affiliation(s)
| | - Vincenzo Palumbo
- 2 Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.,3 Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | - Luca Cicero
- 1 "A. Mirri" Sicily Zooprophilactic Institute, Palermo, Italy
| | | | - Giuseppe Damiano
- 2 Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Salvatore Fazzotta
- 2 Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Salvatore Buscemi
- 2 Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | | |
Collapse
|
27
|
Johnson S, McCracken J, Baidoun F. Tension pneumoperitoneum after bystander cardiopulmonary resuscitation: A case report. Int J Surg Case Rep 2017; 42:227-232. [PMID: 29291538 PMCID: PMC5752217 DOI: 10.1016/j.ijscr.2017.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 12/27/2022] Open
Abstract
Abdominal visceral injuries following cardiopulmonary resuscitation are relatively infrequent. Tension pneumoperitoneum is a serious condition where free intraperitoneal air causes significant pressure decreasing venous return and cardiac output. Gastric perforation after CPR is identified on the lesser curvature, where the area has fewer mucosal folds and is fixed by the hepatogastric ligament. Veress needle desufflation can be an effective means of decompressing an abdomen under increased pressure from free intraperitoneal air.
Introduction Abdominal visceral injuries after cardiopulmonary resuscitation (CPR) are infrequent though can be significant complications of CPR requiring invasive interventions. We present a case of a gastric perforation as a result of bystander CPR. This resulted in tension pneumoperitoneum necessitating abdominal decompression prior to laparotomy and repair. Presentation of case 37-year-old female complained of abdominal pain and distension after return of spontaneous circulation from successful CPR following a drug overdose and cardiopulmonary arrest. Abdominal imaging showed significant amounts of free intraperitoneal air causing compression of the abdominal visceral organs. Patient underwent exploratory laparotomy. Prior to induction of general anesthesia with potential cardiovascular collapse from the tension pneumoperitoneum, the abdomen was decompressed with a spring-loaded insufflation (Veress) needle while the patient was awake. Upon exploration, there were two three-centimeter gastric perforations that were primarily repaired with omental patch. The patient had an uneventful recovery and discharged home on postoperative day four. Conclusion The Veress needle, usually used for insufflating the abdomen during laparoscopy, can also be an effective tool to decompress the abdomen when presented with tension pneumoperitoneum. Abdominal visceral injuries are rare following CPR but do occur and will likely require an invasive intervention. Surviving cardiac arrest as a young person and living without deficits outweighs the risk of a surgical correction for a visceral injury. While resuscitation measures are critical for survival, medical personnel need to be aware of potential complications from resuscitative efforts and potential management strategies.
Collapse
Affiliation(s)
- Sherry Johnson
- Henry Ford Wyandotte Hospital, 2333 Biddle Ave, Wyandotte, MI 48192, USA.
| | - Jessica McCracken
- Henry Ford Wyandotte Hospital, 2333 Biddle Ave, Wyandotte, MI 48192, USA.
| | - Fadi Baidoun
- Henry Ford Wyandotte Hospital, 2333 Biddle Ave, Wyandotte, MI 48192, USA.
| |
Collapse
|
28
|
Wong LFA, Anglim B, Wahab NA, Gleeson N. A review of the open laparoscopic Hasson technique and retrieval of adnexal specimen via umbilicus. J OBSTET GYNAECOL 2017; 37:487-491. [PMID: 28421907 DOI: 10.1080/01443615.2016.1269226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Laparoscopic entry techniques vary amongst surgeons and gynaecologists, with gynaecologists favouring Veress needle entry. Recent RCOG/BSGE recommendations have recommended retrieval of ovarian masses via the umbilical port with resultant less postoperative pain and a faster retrieval time than with retrieval through lateral ports of the same size. This is a prospective observational study reviewing the Hasson entry technique and the introduction of retrieval of specimens via the umbilicus in patients scheduled for a laparoscopy procedure at our day surgery unit. We found no immediate or major surgical complications and all specimens were successfully retrieved through the umbilicus. Pain scores were low. We recommend the technique for extirpative gynaecological surgery. Impact Statement This study confirms that conversion from the closed Veress to the open Hasson technique is achievable in a university hospital setting. Operator confidence during the learning phase is enhanced by the use of ultrasound to locate and measure the depth of the umbilical ligament. Retrieval of benign adnexal specimens through the umbilicus was very satisfactory.
Collapse
Affiliation(s)
- L F A Wong
- a Department of Gynaecological Oncology , St James's Hospital , Dublin , Republic of Ireland
| | - B Anglim
- a Department of Gynaecological Oncology , St James's Hospital , Dublin , Republic of Ireland
| | - N A Wahab
- a Department of Gynaecological Oncology , St James's Hospital , Dublin , Republic of Ireland
| | - N Gleeson
- a Department of Gynaecological Oncology , St James's Hospital , Dublin , Republic of Ireland
| |
Collapse
|
29
|
Johnston WK, Linsell S, Miller D, Ghani KR. Survey of Abdominal Access and Associated Morbidity for Robot-Assisted Radical Prostatectomy: Does Palmer's Point Warrant Further Awareness and Study? J Endourol 2017; 31:283-288. [PMID: 28056561 DOI: 10.1089/end.2016.0402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Laparoscopic access for robot-assisted radical prostatectomy (RARP) is often initiated in the periumbilical location. Palmer's point, located in the left upper quadrant, has been reported as an alternative access site for pelvic laparoscopy to reduce morbidity, but not widely reported among urologists. To better understand surgeons' preferences for access and its associated morbidity during RARP, we surveyed surgeons from two urologic organizations. METHODS An anonymous online questionnaire (SurveyMonkey) consisting of 17 questions that assessed training, experience, and preferences for RARP was emailed in December 2014 and collected until February 2015 to members performing RARP of the Endourology Society (ES) and the Michigan Urological Society Improvement Collaborative (MUSIC). Surgeons were also asked to share their personal experience with a vascular, death or life-threatening event (DOLTE), or bowel injury during RARP. RESULTS Questionnaires were answered by 111 surgeons in total (ES, n = 71 and MUSIC, n = 40) with an estimated total response rate of 5.5%. In total, 77% reported prior experience with the Veress needle method before exposure to RARP and 71% of respondents primarily use the Veress needle for RARP, with 73% reporting access primarily at the periumbilical location. A personal experience with a vascular or a bowel injury during Veress needle insertion was reported in 18% and 9% of surgeons, respectively; furthermore, 26% of respondents were personally aware of at least 1 DOLTE among colleagues (5% reported 3 or more). The majority (56%) of respondents were unaware of Palmer's point, while among the minority aware of Palmer's point, only 33% reported ever using this location. CONCLUSION In this survey, surgeons most commonly access the abdomen at the periumbilical location with a Veress needle for RARP with the majority not aware or utilizing Palmer's point. Nearly one in five surgeons reported a personal experience with a vascular injury during access for RARP. Palmer's point, located away from major vasculature, may reduce the morbidity of access for RARP and warrants further awareness and study.
Collapse
Affiliation(s)
- William K Johnston
- 1 Michigan Institute of Urology, Beaumont School of Medicine, Oakland University , Novi, Michigan
| | - Susan Linsell
- 2 Department of Urology, University of Michigan , Ann Arbor, Michigan
| | - David Miller
- 2 Department of Urology, University of Michigan , Ann Arbor, Michigan
| | - Khurshid R Ghani
- 2 Department of Urology, University of Michigan , Ann Arbor, Michigan
| |
Collapse
|
30
|
Cha JG, Lee HB, Cheong HY, Heo SY, Ragetly GR. Evaluation of a Veress needle for the fluid egress system of stifle arthroscopy in toy dog breeds. Vet Comp Orthop Traumatol 2016; 29:149-55. [PMID: 26846402 DOI: 10.3415/VCOT-15-04-0065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 11/20/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the use of a Veress needle as a fluid egress system for stifle arthroscopy in toy dog breeds. METHODS Cadaveric canine stifle joints (n = 32) were prepared to induce an artificial intra-articular haemorrhagic effect, followed by stifle arthroscopy. The stifles were randomly assigned to one of three groups, and a fluid egress portal was established using a Veress needle (VN), a standard egress cannula (SE), or an intravenous catheter stylet (CS). Time to establish the egress portal, arthroscopic visibility, and egress portal performance were evaluated during the arthroscopy. After the arthroscopic examinations, iatrogenic cartilage lesions were identified and analysed using the percentage area of cartilage damage (%ACD). RESULTS The overall arthroscopic visibility and egress portal performance were not significantly different among the groups. The egress portal establishment was faster for the VN (33 sec) and the CS (34 sec) groups than for the SE (43 sec) group (p = 0.001). On gross joint examination, no iatrogenic laceration was found in the VN group, whereas four out of 10 of the SE and two out of 10 of the CS specimens had linear cartilage excoriation on the stifle joints. The %ACD score of the VN group was lower than those of the SE group (p = 0.009) and the CS group (p = 0.001). CLINICAL SIGNIFICANCE The Veress needle method used in this study was useful to establish a fluid egress system and limit iatrogenic cartilage excoriations. This technique could become the method of choice for stifle arthroscopy, especially in smaller dogs.
Collapse
|
31
|
Nevler A, Har-Zahav G, Rosin D, Gutman M. Safer trocar insertion for closed laparoscopic access: ex vivo assessment of an improved Veress needle. Surg Endosc 2016; 30:779-82. [PMID: 26123325 DOI: 10.1007/s00464-015-4245-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 05/11/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Laparoscopic surgery is widely practiced surgical technique in the modern surgical toolbox. The Veress needle insertion technique, while faster and easier, is associated with higher rates of iatrogenic complications (injury to internal organs, major blood vessels, etc.), morbidity and even mortality with a reported overall risk of 0.32% during surgical interventions. In order to increase the safety and ease of closed insertion technique, we designed and tested an improved prototype of the Veress needle. METHODS The new Veress needle includes a distal expandable portion that allows elevation of the abdominal wall and safe insertion of the first trocar over it. The needle was assessed by measurement of ease of insertion, ease of trocar advancement, associated tissue damage, device integrity and weight-bearing capacity on an ex vivo Gallus domesticus animal model: The prototype was tested over 20 times using different traction forces. The experiment was qualitatively repeated on an ex vivo porcine model. RESULTS In the G. domesticus model, the improved needle supported forces of up to 5.75 kg F. No damage or mechanical malfunction was seen at any stage of the experiment. Needle penetration, ease of trocar insertion, system anchoring and weight-bearing capacity were rated (1-5) by four raters--mean 4.9 ± 0.31. Inter-rater agreement was high (free marginal κ 0.75). The porcine experiment revealed similar ease of use with neither complication nor damage to the abdominal wall. CONCLUSIONS We believe that the new Veress system is easy to use, requires no additional training, non-inferior in its capabilities compared to the traditional Veress needle, with the advantage of improving the safety of the first trocar insertion phase of the operation.
Collapse
|
32
|
Cuss A, Bhatt M, Abbott J. Coming to terms with the fact that the evidence for laparoscopic entry is as good as it gets. J Minim Invasive Gynecol 2014; 22:332-41. [PMID: 25460522 DOI: 10.1016/j.jmig.2014.10.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/27/2014] [Accepted: 10/30/2014] [Indexed: 02/07/2023]
Abstract
Entry to the peritoneal cavity for laparoscopic surgery is associated with defined morbidity, with all entry techniques associated with substantial complications. Debate over the safest entry technique has raged over the last 2 decades, and yet, we are no closer to arriving at a scientifically valid conclusion regarding technique superiority. With hundreds of thousands of patients required to perform adequately powered studies, it is unlikely that appropriately powered comparative studies could be undertaken. This review examines the risk of complications related to laparoscopic entry, current statements from examining bodies around the world, and the medicolegal ramifications of laparoscopic entry complications. Because of the numbers required for any complications study, with regard to arriving at an evidence-based decision for laparoscopic entry, we ask: is the current literature perhaps as good as it gets?
Collapse
Affiliation(s)
- Amanda Cuss
- Royal Hospital for Women, Sydney, Australia and University of New South Wales, Sydney, Australia
| | | | - Jason Abbott
- Royal Hospital for Women, Sydney, Australia and University of New South Wales, Sydney, Australia.
| |
Collapse
|
33
|
Ozdemir A, Gungorduk K, Ulker K, Yasar L, Ertas IE, Gokcu M, Solmaz U, Sanci M. Umbilical stalk elevation technique for safer Veress needle insertion in obese patients: a case-control study. Eur J Obstet Gynecol Reprod Biol 2014; 180:168-71. [PMID: 25027266 DOI: 10.1016/j.ejogrb.2014.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/09/2014] [Accepted: 06/13/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this retrospective study was to compare our umbilical stalk elevation (USE) technique with the classic Veress needle (VN) technique in obese patients. STUDY DESIGN The USE technique was performed on 40 patients. One control per case was randomly selected from among those undergoing the classic VN technique using a random number table. In USE technique, a 12 mm skin incision was created at the superior crease of the umbilical fold, and the underlying subcutaneous adipose tissue was bluntly dissected using the tip of a fine clamp until the umbilical stalk was isolated at the inferior and central part of the incision. Next, the umbilical stalk was covered and held by a towel clip, and the abdominal wall was elevated by upward traction. The VN was then inserted nearly perpendicular to the incision and turned toward the pelvis immediately after resistance to the needle had been lost. A post-hoc power analysis was performed. RESULTS The number of attempts was significantly lower in the USE laparoscopy group than in the classic laparoscopy group (1.2 ± 0.4 vs. 2.1 ± 0.7, respectively; P<0.001). The USE technique group had a slightly shorter abdominal entry time than did the classic technique group (328.52 ± 63.71 vs. 434.95 ± 124.10s; P<0.001). Six (7.5%) failed insufflations occurred in our study (5 patients in the classic group vs. 1 patient in the USE group (P=0.10). CONCLUSION Our novel USE technique can be an effective means of establishing pneumoperitoneum in obese patients undergoing gynecologic laparoscopic procedures.
Collapse
Affiliation(s)
- Aykut Ozdemir
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey.
| | - Kemal Gungorduk
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Kahraman Ulker
- Department of Obstetrics and Gynecology, Kafkas University School of Medicine, Kars, Turkey
| | - Levent Yasar
- Department of Obstetrics and Gynecology, Bakırkoy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Ibrahim Egemen Ertas
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Mehmet Gokcu
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Ulas Solmaz
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Muzaffer Sanci
- Department of Gynecologic Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| |
Collapse
|