Right Intercostal Insertion of a Veress Needle for Laparoscopy in Dogs

Abstract

Right intercostal VN insertion facilitates pneumoperitoneum in dogs with few consequential complications. No significant difference was found between entry sites; however, the mid distance insertion site in the last palpable intercostal space with dog positioned in dorsal recumbency is likely to result in less complications.

Influence of 2 Veress needles and 4 insertion sites on Veress needle penetration depth: A comparative study in cadaveric dogs

“…In a dog cadaver study, the interpretations of tissue impedance measurements resulted in a 90% accuracy and 100% specificity for identification of incorrect VN placement . In another veterinary study that evaluated intercostal insertions of VN, the authors confirmed that correct intraperitoneal placement was achieved after a clear double click was heard . In the present study, a 100% rate of correct intraperitoneal placement was found when the double‐click test and the spring‐back test with the red‐colored built‐in marker were used for VN placement in cooled canine cadavers.…”

“…The double click refers to 2 clicks that can be heard during VN insertion. The first click corresponds to perforation of the muscle fascia when the stylet retracts, and the second click is heard when the stylet springs forward after the peritoneum is perforated . Spring back refers to the exposure and then disappearance of the red marker in the stylet as the stylet retracts and then springs forward in the proximal and distal positions, respectively.…”

“…The risk of damage to the underlying tissues arising from blind insertion of a VN into the peritoneal cavity is well recognized, and complications associated with VN entry have been reported in both man and dogs . These complications include injury to the abdominal or thoracic wall vasculature, injury to intra‐abdominal or intrathoracic vessels, penetration of solid organs or hollow viscera, subcutaneous emphysema, and gas embolism .…”

Laparoscopic-Assisted Surgical Procedures

“…The modified Hasson and Veress needle techniques have been described in greater detail elsewhere. 6,7 Because organs and specimens are generally exteriorized from the abdominal cavity in LA procedures, protection of wound edges and minimizing tissue trauma are important considerations. Placement of an Alexis wound retractor device (Applied Medical, Rancho Santa Margarita, CA) can facilitate optimizing exposure and minimize incision length.…”

“…A modified version of this technique with the Veress needle placed through the last palpable intercostal space has been described, and was demonstrated to facilitate pneumoperitoneum with few consequential complications. 6 In a modified Hasson technique, a 1-cm skin incision is made in the desired site of portal placement. Blunt dissection to the linea alba is followed by a small 3-mm to 4-mm stab incision penetrating the peritoneal cavity.…”