The use of veress needle and 10-mm trocar (VN) versus direct trocar insertion (DTI) in the beginning of laparoscopy

Dabirashrafi, H; Mohammad, Khajedalouee; Tabrizi, NM; Azari, Amir A.; Behjatnia, Y

doi:10.1016/s1074-3804(05)80893-x

Cited by 6 publications

(3 citation statements)

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“…This in agreement with Dabirasharafi et al [34] , Yerdel et al [23] , Altun et al [35] and Ahmed et al [36] . Gunenc et al [15] reported total complication rates of 15.7 and 3.3% with the VN and DT techniques, which is comparable with the results of this study.…”

Section: Discussionsupporting

confidence: 89%

Direct Trocar versus Veress Needle Entry for Laparoscopy: A Randomized Clinical Trial

Zakherah¹

2010

Gynecol Obstet Invest

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Aims: To compare direct trocar (DT) to Veress needle (VN) entry for the creation of pneumoperitoneum during laparoscopy with regard to the duration of the procedure, volume of gas used, ease of performance, and frequency of complications. Design: A randomized clinical trial. Subjects and Methods: One thousand patients scheduled to undergo diagnostic laparoscopy were recruited for the study. They were randomly allocated to either DT entry (group A, n = 500) or VN (group B, n = 500) for pneumoperitoneum. The laparoscopic procedures were performed by the same surgeon. Outcomes: The duration of the procedure, volume of gas consumption, ease of performance and frequency of complications were analyzed. Results: Patients in the 2 groups had similar demographic characteristics. The mean duration of the procedure was significantly shorter in group A (2.2 ± 0.7 min, 95% CI 2.14–2.26) than in group B (8.2 ± 1.4 min, 95% CI 8.08–8.32; p < 0.0001). The mean gas consumption was significantly less in group A (2.6 ± 0.9 liters, 95% CI 2.52–2.68) than in group B (8.4 ± 2.6 liters, 95% CI 8.17–8.63; p < 0.0001). No major complications in both groups were encountered. Minor complications were significantly less in group A (0.4%, 95% CI 0.77–3.23) than in group B (14%, 95% CI 10.96–17.04; p < 0.0001). Conclusions: DT entry is a safe alternative to the VN entry technique for the creation of pneumoperitoneum. Such an approach has further advantages such as less cost and instrumentation and rapid creation of pneumoperitoneum.

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Section: Discussionsupporting

confidence: 89%

Direct Trocar versus Veress Needle Entry for Laparoscopy: A Randomized Clinical Trial

Zakherah¹

2010

Gynecol Obstet Invest

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“…Introduction of the trocar can be performed either in a closed or an open procedure and can be preceded or not preceded by insufflation through a Verres' needle [35]. The most important principle to follow for the introduction of the trocars is to avoid areas where adhesions are likely.…”

Section: Trocar Placement and Positionmentioning

confidence: 99%

Complications of Laparoscopic Hysterectomy: Avoid the Risks

Carter¹

1996

Diagnostic and Therapeutic Endoscopy

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Results of more than 1500 laparoscopic hysterectomies have been reported since 1989. The complication rate is 10 to 11% in expert hands. However, a complication rate of 60% was reported in one community hospital series. The risks of laparoscopic hysterectomy are acceptable at 10% but not at 60%. Practitioners of laparoscopic assisted vaginal hysterectomy must review and understand the risks associated with the procedure in order to avoid them. This article addresses the complications of laparoscopic hysterectomy and gives techniques to avoid them.

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“…The patient should be instructed for all advanced laparoscopic procedures and undergo a bowel cleansing procedure with the use ofan osmotic agent such as GoLITELY (25,28 (2,(36)(37)(38).…”

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confidence: 99%

Laparoscopic Gynecology Procedures: Avoid the Risk

Carter¹

1995

Diagnostic and Therapeutic Endoscopy

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Laparoscopic approaches to gynecological surgery have been developed by an elite group of highly skilled surgeons. As these procedures become more prevalent in the general gynecological approach to disease and the general gynecologist' s approach to treatment, the complication rate for these procedures is likely to increase. In an effort to assist in avoiding these complications, guidelines for the performance of laparoscopic gynecological procedures need to be established. This article presents approaches to the most common gynecological procedures that can assist in the prevention of complications.KEY WORDS: Laparoscopy, complications, bowel injury, Richter's hernia INTRODUCTION A short review of the literature on the laparoscopic hysterectomy (1-19) revealed the following complications: bladder injuries including lacerations, punctures, vesiclevaginal fistulas; ureteral injuries including ureterovesicle fistulas, ureteral transections, and cauterizations; bowel injuries including enterotomies, thermal injuries, and herniations into trocar sites; nerve injuries; hemorrhage both intraoperative and postoperative, some requiring transfusion; injuries to abdominal wall vessels and retroperitoneal vessels; infections including pelvic abscesses requiring drainage, cellulitis, and pneumonia, with one postoperative case of pneumonia resulting in death; anesthetic problems including cardiac arrythmias and pulmonary edema; and vascular problems including deep venous thrombosis and pulmonary embolus.Of all the laparoscopic gynecological procedures, only the complication rate of the laparoscopic-assisted vaginal hysterectomy (LAVH) and laparoscopic hysterectomy has been studied and recorded. In one such study by Padial et al. (13) surgery (20-27).The patient should be instructed for all advanced laparoscopic procedures and undergo a bowel cleansing procedure with the use ofan osmotic agent such as GoLITELY (25,28 (2,(36)(37)(38).This site, however, has three major disadvantages. First, the transverse colon will frequently lay directly under or even caudad to the umbilical site. The second disadvantage is that the mesentery of the bowel also frequently lies directly under the umbilical site. Finally, the aorta, vena cava, and especially the left common iliac vein are frequently in close proximity to, directly below, or caudad to the umbilical site. Therefore, when the intraumbilical incision is made (which is preferable to a subumbilical incision because of the direction of the lines of Langham at the umbilical site) the Veress needle must be inserted only millimeters through the fascia, which is elevated under tension if the Veress needle is inserted in a vertical direction. If the Veress needle is inserted in a caudad direction, the skin should be elevated and the Veress needle inserted in a direction toward the uterus in the deep pelvis. This technique will traverse fat, fascia, and peritoneum before entry.If the Veress needle technique is used, the position ofthe Veress needle must be confimed by injection of 20 ml ...

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The use of veress needle and 10-mm trocar (VN) versus direct trocar insertion (DTI) in the beginning of laparoscopy

Cited by 6 publications

References 0 publications

Direct Trocar versus Veress Needle Entry for Laparoscopy: A Randomized Clinical Trial

Direct Trocar versus Veress Needle Entry for Laparoscopy: A Randomized Clinical Trial

Complications of Laparoscopic Hysterectomy: Avoid the Risks

Laparoscopic Gynecology Procedures: Avoid the Risk

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