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Surgical Endoscopy

, Volume 30, Issue 2, pp 779–782 | Cite as

Safer trocar insertion for closed laparoscopic access: ex vivo assessment of an improved Veress needle

  • Avinoam NevlerEmail author
  • Gil Har-Zahav
  • Danny Rosin
  • Mordechai Gutman
Dynamic Manuscript

Abstract

Introduction

Laparoscopic surgery is widely practiced surgical technique in the modern surgical toolbox. The Veress needle insertion technique, while faster and easier, is associated with higher rates of iatrogenic complications (injury to internal organs, major blood vessels, etc.), morbidity and even mortality with a reported overall risk of 0.32 % during surgical interventions. In order to increase the safety and ease of closed insertion technique, we designed and tested an improved prototype of the Veress needle.

Methods

The new Veress needle includes a distal expandable portion that allows elevation of the abdominal wall and safe insertion of the first trocar over it. The needle was assessed by measurement of ease of insertion, ease of trocar advancement, associated tissue damage, device integrity and weight-bearing capacity on an ex vivo Gallus domesticus animal model: The prototype was tested over 20 times using different traction forces. The experiment was qualitatively repeated on an ex vivo porcine model.

Results

In the G. domesticus model, the improved needle supported forces of up to 5.75 kg F. No damage or mechanical malfunction was seen at any stage of the experiment. Needle penetration, ease of trocar insertion, system anchoring and weight-bearing capacity were rated (1–5) by four raters—mean 4.9 ± 0.31. Inter-rater agreement was high (free marginal κ 0.75). The porcine experiment revealed similar ease of use with neither complication nor damage to the abdominal wall.

Conclusions

We believe that the new Veress system is easy to use, requires no additional training, non-inferior in its capabilities compared to the traditional Veress needle, with the advantage of improving the safety of the first trocar insertion phase of the operation.

Keywords

Laparoscopy Veress needle Patient safety Surgical complications 

Notes

Acknowledgments

We acknowledge Dr. David Castel DVM and the animal laboratory of the Neufeld Cardiac Research Institute for their support of this study.

Disclosures

Drs. Avinoam Nevler and Gil Har-Zahav have a patent pending related to the prototype design presented in this study. Drs. Danny Rosin and Mordechai Gutman have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (WMV 22619 kb)

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Avinoam Nevler
    • 1
    • 2
    Email author
  • Gil Har-Zahav
    • 1
  • Danny Rosin
    • 1
  • Mordechai Gutman
    • 1
  1. 1.Department of General Surgery and TransplantationChaim Sheba Medical Center (Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel)Tel-HashomerIsrael
  2. 2.The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2012Chaim Sheba Medical CenterTel-HashomerIsrael

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