Safer laparoscopic trocar entry: It's all about pressure

Tsaltas, Jim; Pearce, Scott; Lawrence, Anthony; Meads, Alan; Mezzatesta, Joseph; Nicolson, Scott

doi:10.1111/j.1479-828x.2004.00228.x

Cited by 14 publications

(12 citation statements)

References 8 publications

(14 reference statements)

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“…The abdominal aorta and vena cava, as well as the common iliac vessels, are particularly prone to injury during Veress needle puncture in the vicinity of the umbilical scar 10 . Despite the low prevalence of this occurrence (0.05% to 0.5%), mortality rates range between 8% and 17%, reaching 21% when there is unnoticed associated intestinal lesions [4][5][6][7][8][9][10][11] . The severity of this type of iatrogenic injury is minimized when the punctures are made in locations away from the midline 12 15 .…”

Section: Original Articlementioning

confidence: 99%

“…In a study with 155,987 laparoscopic procedures, there was an 81% rate of Veress needle usage 7 . The classic site of puncture is the midline of the abdomen, near the umbilical scar 8 . In this region, the puncture presents with risks of large vessels injury due to the short distance from the anterior abdominal wall to these vascular retroperitoneal structures 9 .…”

Section: Original Articlementioning

confidence: 99%

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Punção com agulha de Veress no hipocôndrio esquerdo para a criação do pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pacientes não selecionados

Becker

Azevedo

Azevedo³

et al. 2011

Rev. Col. Bras. Cir.

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Veress needle insertion into the left hypochondrium for creation of pneumoperitoneum: diagnostic value of tests to determine the position of the needle in unselected patients Original Article Original Article Original Article Original Article Original Article Veress needle insertion into the left hypochondrium for creation Veress needle insertion into the left hypochondrium for creation Veress needle insertion into the left hypochondrium for creation Veress needle insertion into the left hypochondrium for creation Veress needle insertion into the left hypochondrium for creation of pneumoperitoneum: diagnostic value of tests to determine the of pneumoperitoneum: diagnostic value of tests to determine the of pneumoperitoneum: diagnostic value of tests to determine the of pneumoperitoneum: diagnostic value of tests to determine the of pneumoperitoneum: diagnostic value of tests to determine the position of the needle in unselected patients position of the needle in unselected patients position of the needle in unselected patients position of the needle in unselected patients position of the needle in unselected patients Punção com agulha de Veress no hipocôndrio esquerdo para a criação do Punção com agulha de Veress no hipocôndrio esquerdo para a criação do Punção com agulha de Veress no hipocôndrio esquerdo para a criação do Punção com agulha de Veress no hipocôndrio esquerdo para a criação do Punção com agulha de Veress no hipocôndrio esquerdo para a criação do pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pacientes não selecionados pacientes não selecionados pacientes não selecionados pacientes não selecionados pacientes não selecionados OTÁVIO To assess the effectiveness of the Veress needle puncture in the left hypochondrium and the accuracy of the tests described for the intraperitoneal correct positioning of the tip of the Veress needle in an unselected population. Methods:Methods: Methods: Methods: Methods: Ninetyone patients consecutively scheduled for Videolaparoscopy had the abdominal wall punctured in the left hypochondrium. There were no exclusion criteria. The patients received general anesthesia and mechanical ventilation according to the protocol. After puncturing five tests were used to confirm the positioning of the needle tip within the peritoneal cavity: aspiration test -AT; resistance to infusion -Pres; recovery of the infused fluid -Prec, dripping test -DT, and test of initial intraperitoneal pressure -IIPP. The test results were compared with results from literature for groups with defined exclusion criteria. The results were used for calculating sensitivity (S) specificity (E), positive predictive value (PPV) and negative predictive value (NPV). Inferential...

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Section: Original Articlementioning

confidence: 99%

Section: Original Articlementioning

confidence: 99%

Punção com agulha de Veress no hipocôndrio esquerdo para a criação do pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pacientes não selecionados

Becker

Azevedo

Azevedo³

et al. 2011

Rev. Col. Bras. Cir.

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“…This corroborates the hypothesis that elevated intraperitoneal pressure protects the intra-abdominal structures from injury caused by the first trocar. No injury caused by blind insertion of the first trocar was reported in a study involving 1,150 patients submitted to laparoscopy under intraperitoneal pressure of 25 mmHg [14].…”

mentioning

confidence: 97%

“…No clinical complications have been shown to arise from transitory elevation of intraperitoneal pressure [12,14]. However, it is known that extremely high levels of intraperitoneal pressure for longer periods of time can cause physiological and structural changes, directly related to the tension levels caused by the high pressure [15][16][17][18][19][20][21].…”

mentioning

confidence: 99%

Creation of pneumoperitoneum: noninvasive monitoring of clinical effects of elevated intraperitoneal pressure for the insertion of the first trocar

et al. 2009

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Transitory, high intraperitoneal pressure (20 mmHg for 5 min) for insertion of the first trocar resulted in changes in HR, MAP, ETCO(2), and ITP that were within the normal range, and no adverse clinical effects were observed. Therefore, the use of transitory, high intraperitoneal pressure is recommended to prevent iatrogenic injury during blind insertion of the first trocar. Nevertheless, it is not clear that this method would be safe in patients with moderate to severe chronic obstructive pulmonary disease.

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“…Nevertheless, it is suggested that the Veress angle of entry should vary (45°in nonobese women and 90°in obese women) because CT abdominal imaging [112]) and visualization at laparoscopy [113] have shown that the location of the underlying aortic bifurcation (which may be prone to Veress injury) tends to be directly under the umbilicus in nonobese women or 2-3 cm caudal to the umbilicus in obese women. Prospective observational studies have shown that higher intraabdominal CO 2 insufflated pressures achieve greater anterior abdominal wall splinting and intraabdominal CO 2 gas bubble space [108,[153][154][155]. An IAP of 25 mmHg has been shown to achieve a maximum safe distance between the anterior abdominal wall and underlying abdominal contents without compromising cardiorespiratory function [156,157].…”

Section: Controlled Vertical (90°) Veress Needle Entry (Steps 4 and 5)mentioning

confidence: 99%

Laparoscopic entry techniques: clinical guideline, national survey, and medicolegal ramifications

Varma

Gupta

2008

Surg Endosc

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Background This study aimed to establish criteria for safe laparoscopic entry through a systematic literature search and evidence-based medicine appraisal, to determine surgeon preferences for laparoscopic entry in the United Kingdom, and to appraise the medicolegal ramifications of complications arising from laparoscopic entry. Methods A systematic literature search of MEDLINE and EMBASE (1996-2007) was performed as well as a national surgeon survey by questionnaire (May-December 2006). Results Laparoscopic entry criteria involving 10 steps were established based on the systematic literature search and evidence-based critical appraisal. The national survey had 226 respondents, with the majority aware of the Middlesbrough consensus or Royal College of Obstetricians and Gynaecologists [RCOG]-sourced guidance. There was considerable variation in preferred laparoscopic entry techniques. Currently, there is clear judicial guidance on the medicolegal stance toward laparoscopic entry-related complications. Conclusions Despite widespread awareness of laparoscopic entry guidelines, there remains considerable variation in the techniques adopted in clinical practice. Unless practice concurs with recommended guidance, women undergoing laparoscopy will be exposed to increased unnecessary operative risk. Laparoscopic entry-related injury in an uncomplicated woman is considered negligent practice according to UK legal case law.

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Safer laparoscopic trocar entry: It's all about pressure

Cited by 14 publications

References 8 publications

Punção com agulha de Veress no hipocôndrio esquerdo para a criação do pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pacientes não selecionados

Punção com agulha de Veress no hipocôndrio esquerdo para a criação do pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pacientes não selecionados

Creation of pneumoperitoneum: noninvasive monitoring of clinical effects of elevated intraperitoneal pressure for the insertion of the first trocar

Laparoscopic entry techniques: clinical guideline, national survey, and medicolegal ramifications

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