Injuries caused by Veress needle insertion for creation of pneumoperitoneum: a systematic literature review

Azevedo, João Luiz Moreira Coutinho; Azevedo, Otávio Cansanção; Miyahira, Susana Abe; Miguel, Gustavo Peixoto Soares; Becker, Otávio Monteiro; Hypólito, Octávio Henrique Mendes; Machado, Afonso Cesar Cabral Guedes; Cardia, Wellington; Yamaguchi, Gilmara Aguiar; Godinho, Lola; Freire, Dalmer Faria; Almeida, Carlos Eduardo Saldanha de; Moreira, Camila Hobi

doi:10.1007/s00464-009-0383-9

Cited by 143 publications

(84 citation statements)

References 26 publications

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“…It is less than 0.2% in the case of diagnostic laparoscopy [5,8], but more frequent in operative laparoscopy (up to 8% in laparoscopic-assisted vaginal hysterectomy) and frequently caused by sharp electrosurgical dissection [5,8]. Jelovsek et al [9] concluded that the overall incidence of injury to the lower urinary tract in 126 consecutive total laparoscopic hysterectomies was 4.0%, but Lafay Pillet et al [10] had a rate of bladder injuries of 1% in 1,501 procedures, decreasing with the surgeon experience and others report even less [11]. Although the majority of bladder injuries are detected at the time of surgery, either directly by the surgeon seeing urinary spilling or by the anaesthetist noticing gas or blood in the urine bag [7,12], Jelovsek et al [9] recommended the performance of cystoscopy with intravenous indigo-carmine dye at the time of total laparoscopic hysterectomy.…”

Section: Discussionmentioning

confidence: 99%

Urinary Peritonitis due to Unrecognized Bladder Injury During Laparoscopy: A Case Report

Gascón

2013

World J Nephrol Urol

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Bladder injury is a possible complication of laparoscopic surgery. If it is not identified, the subsequent clinical presentation is usually unclear and confusing. We report the case of a 31-year-old patient without an obstetric history. A laparoscopic ovarian cystectomy was performed and a bladder perforation due to the use of an accessory suprapubic trocar must have occurred. However, the perforation was not identified as such during the operation nor in the postoperative period. This injury subsequently caused unclear symptoms with diffuse and persistent abdominal pain, sometimes intense and focused on the right side, in the days following the surgery. The observation of the globe of the Foley catheter with trasvaginal ultrasound in an extravesical location suggested bladder injury with spilling of the urine and catheter into the peritoneal cavity. An immediate laparotomy was performed, revealing a small bladder perforation on the front pre-peritoneal face and another 1-cm perforation in the upper part of the bladder that were corrected. Postsurgical progress was then normal. A high urachal vesical extension or filled bladder, no visual control or a too-low introduction of the suprapubic trocar can produce an unrecognised bladder perforation. Attention must be paid to irritating and persistent abdominal pain of urinary peritonitis, presumed anuria corrected after the positioning of the Foley catheter, variable haematuria, leukocytosis, and eventual electrolytic alterations without fever. The key to the diagnosis of bladder injury is awareness of this clinical entity.

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Section: Discussionmentioning

confidence: 99%

Urinary Peritonitis due to Unrecognized Bladder Injury During Laparoscopy: A Case Report

Gascón

2013

World J Nephrol Urol

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“…[1] Many surgeons have surpassed the learning curve for most procedures and therefore mayor complications have been reduced significantly. Azevedo et al [15] in a cohort of in 696,502 patients who underwent a laparoscopic procedure using the closed technique (Veress needle) to enter the abdominal cavity have reported an incidence rate of vascular and visceral injuries of 0.018% and of 0.0024%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…This is due largely to successful personal experiences and the fact that the open technique has been linked to some technical difficulties such as increased time to access the peritoneal cavity compared to the closed technique and gas leakage through incision. [13][14][15][16][17][18] In a meta-analysis by Bonjer et al [19] vascular injuries occurred in 0.083% of patients using the closed technique and in 0.075% of patients using the open technique, while visceral injuries occurred in 0.048% of patients using the closed technique and in 0.0% using the open technique. The meta-analysis showed a tendency to eliminate visceral injuries and reduce the risk of major complications with the open technique.…”

Section: Discussionmentioning

confidence: 99%

Trans umbilical laparoscopic access during laparoscopic procedures

Pozzo

Arrangoiz

Cordera

et al. 2016

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Introduction: The advent of laparoscopic surgery is one of the most important advances in modern surgical technique. In order to perform laparoscopic procedures it is necessary to first access the peritoneal cavity and establish a pneumoperitoneum. The placement of the first port remains a critical step in laparoscopic surgery. In order to minimize complications associated with placement of this first trocar, several techniques have been reported. We describe a surgical technique that has been developed by our surgical group that provides a quick, safe, and reliable initial access to the peritoneal cavity that is accompanied by excellent functional and cosmetic results. Methods: Retrospective cohort of patients who underwent various laparoscopic procedures by our surgical group using our modified open technique for accessing the peritoneum from January 2000 to September 2012. We excluded patients who had a prior midline laparotomy with involvement of the umbilicus, but not those with previous transverse umbilical herniorrhaphies. Results: We identified 963 patients (M = 419; F = 544) in the study period. Average age of the patients was 40 years (range: 15-83). Median follow up of 2.8 years (range: 6-144 months). No complications occurred during the insertion of the first trocar. A physiologic defect was identified in the umbilical region in all patients who had no history of previous abdominal surgery in that region. Postoperative complications occurred in 39 patients (4.0%). The most common complication was a postoperative seroma, which occurred in 24 patients (2.4%). Superficial surgical site infection occurred in eight patients (0.84%), hematoma in two patients (0.21%), and incisional hernias in the umbilical port site in five patients (0.51%). The average time to access the peritoneal cavity was 1.5 minutes (range: 1-7). Conclusions: We describe a modified open technique for accessing the peritoneal cavity through a small congenital umbilical defect that is almost universally present. This technique is quick, safe, reliable, simple, and easy to learn. It is associated with minimal morbidity and has excellent cosmetic results. Based on our experience, we believe that this method provides surgeons with an effective and safe way to insert the first trocar and we recommend it as a routine procedure to access the peritoneal cavity for abdominal laparoscopic surgery.

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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%

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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Injuries caused by Veress needle insertion for creation of pneumoperitoneum: a systematic literature review

Abstract: The insertion of the Veress needle in the abdominal midline, at the umbilicus, poses serious risk to the life of patients. Therefore, further studies should be conducted to investigate alternative sites for Veress needle insertion.

Cited by 143 publications

References 26 publications

Urinary Peritonitis due to Unrecognized Bladder Injury During Laparoscopy: A Case Report

Urinary Peritonitis due to Unrecognized Bladder Injury During Laparoscopy: A Case Report

Trans umbilical laparoscopic access during laparoscopic procedures

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

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