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A negative pressure–based visualization technique for abdominal Veress needle insertion

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Abstract

Purpose

Abdominal Veress needle insertion is commonly performed to generate a pneumoperitoneum during laparoscopy. Various safety tests are conducted to confirm accurate needle tip positioning into the abdominal cavity. However, these occasionally yield unclear results and do not help directly visualize the peritoneum puncture. We validated a negative pressure–based technique that helps instantly visualize the moment of the Veress needle entry into the abdominal cavity.

Methods

This study included 761 patients who underwent laparoscopic hernioplasty between 2003 and 2021 that entailed pneumoperitoneum creation using a Veress needle. They were divided into conventional technique (CON) and negative pressure visualization technique (NPV) groups. The patients were propensity score–matched (1:1) to minimize selection bias. To determine whether the technique gave a clear result to the surgeon and precisely informed the moment of entry, failed entry and emphysematous complications were compared between the groups.

Results

The propensity score–matching yielded 105 pairs in the matched CON and NPV groups. Failed entry did not occur in the NPV group, whereas it occurred in 8 patients (7.6%) in the CON group (p = 0.004). No patient experienced extraperitoneal emphysema in the matched NPV group, whereas 7 patients (6.7%) in the CON group did (p = 0.007). The groups did not differ in the incidence of omental or mesenteric emphysema.

Conclusion

The NPV eliminated the incidence of failed entry and decreased the incidence of extraperitoneal emphysema, indicating that it could simply and adequately inform the moment of needle entry into the abdominal cavity.

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Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan

    Takanobu Onoda, Masanori Sato, Kakeru Torii, Koji Inamori, Norihiko Shiiya & Hidetoshi Wada

  2. Department of Surgery, Yaizu City Hospital, Yaizu, Shizuoka, Japan

    Takanobu Onoda

  3. Faculty of Social Policy and Administration, Hosei University, Machida, Tokyo, Japan

    Eisaku Okada

  4. Department of Surgery, Shimada General Medical Center, Shimada, Shizuoka, Japan

    Masashi Nozawa & Hidetoshi Wada

Authors
  1. Takanobu Onoda
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  2. Masanori Sato
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  3. Kakeru Torii
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  4. Koji Inamori
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  5. Eisaku Okada
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  6. Masashi Nozawa
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  7. Norihiko Shiiya
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  8. Hidetoshi Wada
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Contributions

Takanobu Onoda developed the method, reviewed the videos, collected and analyzed the data, and drafted the manuscript. Masanori Sato designed the study, reviewed the videos, collected the data, and revised the manuscript with conceptual and editorial input. Kakeru Torii reviewed the videos and collected the data. Koji Inamori collected the data, and Eisaku Okada assisted with and reviewed the statistical analyses. Masashi Nozawa, Norihiko Shiiya, and Hidetoshi Wada revised the manuscript.

Corresponding author

Correspondence to Masanori Sato.

Ethics declarations

Ethics approval and consent to participate

This study was approved by the Hamamatsu University School of Medicine Independent Ethics Committee (Permission number: 20–294). The requirement for patient consent was waived by the committee. Patient permission was requested on the institute’s website, and opt-out consent was obtained from the patients.

Consent for publication

The authors affirm that the participant provided informed consent for publication of the images in Fig. 2 and the supplemental movie.

Conflict of interest

The authors declare no competing interests.

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Onoda, T., Sato, M., Torii, K. et al. A negative pressure–based visualization technique for abdominal Veress needle insertion. Langenbecks Arch Surg 407, 2105–2113 (2022). https://doi.org/10.1007/s00423-022-02504-w

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  • DOI: https://doi.org/10.1007/s00423-022-02504-w

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