Induction of Pneumoperitoneum in Morbidly Obese Patients

Schwartz, Michael L.; Drew, Raymond L; J, Andersen

doi:10.1381/096089203322190817

Cited by 33 publications

(25 citation statements)

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“…Contraction and expansion of the diaphragm during breathing prevent peritoneal adhesions between intra-abdominal structures and the abdominal wall in the left hypochondriac region. Insertion of the Veress needle into the left hypochondrium is therefore the method of choice for some surgeons when operating on patients who are obese or have undergone laparotomy 11,12 . Although in theory Veress needle insertion into the left hypochondrium is safer than insertion into the midline, there are no comparative studies in the literature to corroborate that.…”

Section: Methodsmentioning

confidence: 99%

Veress needle insertion in the left hypochondrium in creation of the pneumoperitoneum

Azevedo

Sorbello³

et al. 2006

Acta Cir. Bras.

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PURPOSE: To test the efficacy of the puncture in the left hypochondrium as an alternative method. METHODS: Sixty-two patients randomly distributed into two groups were studied: Group LH, puncture in the left hypochondrium (n=30), and Group ML, puncture in the abdominal midline (n=32). The following were assessed: needle positioning tests, number of failed attempts at needle insertion, and time needed for creation of pneumoperitoneum. Gas flow, volume and intraperitoneal pressure were recorded at every 20 seconds, until a 12 mmHg pressure was reached inside the peritoneal cavity. RESULTS: A similar number of positive results for the needle positioning tests were observed in both groups. Two failed attempts to reach the peritoneal cavity were observed in Group ML and one in Group LH. The time necessary for the creation of pneumoperitoneum was on average 3 minutes and 46 seconds for Group LH, and 4 minutes and 2 seconds for Group ML. Average gas flow, volume and pressure were equivalent for both groups. CONCLUSION: Puncture in the left hypochondrium was as effective as puncture in the abdominal midline for the creation of pneumoperitoneum.

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Section: Methodsmentioning

confidence: 99%

Veress needle insertion in the left hypochondrium in creation of the pneumoperitoneum

Azevedo

Sorbello³

et al. 2006

Acta Cir. Bras.

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“…However, the greater security of the puncture in the left hypochondrium in comparison to the one in the umbilicus can only be deduced from considerations regarding the topographical relationships of the structures at risk, with special attention to the midline retroperitoneal great vessels 9 and to the preferential topography of the midline adhesions. There are reports of lower risk of iatrogenic injuries [12][13][14][15] when the puncture is made in the left hypochondrium because it is out of the midline, where there is greater chance of injury of major retroperitoneal vessels [12][13] . Nonetheless, for the left hypochondrium puncture one must take into account the risk of injury to the superior epigastric vessels and structures immediately posterior to the anterior abdominal wall at the puncture site, such as the gastric body, transverse colon and greater omentum.…”

Section: Discussion Discussion Discussion Discussionmentioning

confidence: 99%

“…The puncture in the left upper quadrant has been mentioned as being safe, without major risk of iatrogenic injury [12][13][14][15][16] . It should be noted that in the left upper quadrant the occurrence of internal adhesions is very rare, as it is known that the respiratory movements of the diaphragm constantly mobilize structures in this region and hamper the adherence to the anterior abdominal wall.…”

Section: Original Articlementioning

confidence: 99%

“…Hence, the puncture in the left hypochondrium is preferred by some surgeons in patients with previous laparotomy 13 . There are also surgeons who perform bariatric surgeries and prefer the left upper quadrant for the creation of pneumoperitoneum in their patients 14 . This preference is due to the fact that in obese patients the open technique presents additional difficulties due to excess weight and puncture in the midline is dangerous because of the thickness of the fat tissue and the high position of the umbilicus in the abdomen.…”

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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“…Women who are extremely thin [111][112][113], obese [114][115][116][117], or known to have abdominal adhesions are at increased risk for laparoscopic entry-related injury at the umbilical entry point. The estimated risks for umbilical and/or anterior abdominal wall adhesions are 0-5% for women with no prior laparoscopic surgery, 20-30% for those with a previous suprapubic laparotomy, and 50-65% for those with a previous midline laparotomy .…”

Section: Suitability Criteria (Step 1)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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Induction of Pneumoperitoneum in Morbidly Obese Patients

Abstract: Percutaneous induction of a pneumoperitoneum with the Veress needle in the left upper quadrant is a safe and effective technique in morbidly obese patients.

Cited by 33 publications

References 1 publication

Veress needle insertion in the left hypochondrium in creation of the pneumoperitoneum

Veress needle insertion in the left hypochondrium in creation of the pneumoperitoneum

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

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

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