A novel Veress needle mechanism that reduces overshooting after puncturing the abdominal wall

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.

Pre-clinical evaluation of the new veress needle+ mechanism on thiel-embalmed bodies: a controlled crossover study – Experimental research

“…The performance with Thiel-embalmed human cadavers is comparable with the results from the in-vitro experiments 7 . However, the data also indicate that participants need to learn how to hold the needle in a proper way for the mechanism to fully dislodge as the first attempts often went wrong.…”

“…A construction was designed which disconnects the grip-part (which has the surgeon’s fingers on it) from the VN at exactly the same moment when the blunt inner stylet of the VN springs forward, thereby immediately removing the (kinetic) force from the VN. In a previous study, the VN + was evaluated in a benchtop setup covered with an isolated porcine abdominal wall, showing a significant reduction in overshoot of more than 50% 7 .…”

Needle-Probe Optical Coherence Tomography for Real-Time Visualization of Veress Peritoneal Needle Placement in a Porcine Model: A New Safety Concept for Pneumoperitoneum Establishment in Laparoscopic Surgery

“…A new mechanism has also been designed to improve the safety of peritoneal puncture with a Veress needle. Postema et al designed a novel Veress needle preventing the puncturing acceleration of the tip of the Veress needle by decoupling the surgeon’s hand from the needle immediately after entering the abdomen [ 22 ]. They showed that it could reduce overshooting with a minimum of 50% in a standardized ex vivo setting on fresh porcine abdominal wall specimens.…”

The relevance of Veress needle overshooting reduction; A Survey among 365 surgeons

“…In an attempt to nd an affordable solution that stays close to the original design and that does not rely on additional measurement devices, actuators or vacuum systems, the veressPLUS safety mechanism has been developed recently [12]. This safety mechanism decouples the driving force generated by the hand and arm of the user as soon as the needle punctures through the peritoneum and was rst validated in a benchtop model and subsequently in a pre-clinical setting on Thiel embalmed bodies at the Department of Anatomy at the University of Malta [13].…”