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

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Abstract

Background

The aim of this study was to assess the prevalence, risks, and outcomes of injuries caused by the Veress needle described in the literature.

Methods

Iatrogenic injuries caused by Veress needle insertion during diagnostic or therapeutic laparoscopies in humans were researched, with no language restriction, in the Medline, Lilacs, Embase, Scielo, and Cochrane Library databases. The following words were combined: “Veress” or “insufflation needle” or “pneumoperitoneum needle,” and “complications” or “injuries” or “lesions.” The bibliographic references of the selected articles were also analyzed. We considered the following: (1) number of injuries described in the literature, (2) relationship between number of injuries and number of patients who underwent Veress needle insertion in the studies that reported Veress needle injury, (3) organs and structures injured (retroperitoneal vessels, digestive tract, and self-limited, minor injuries), and (4) outcome (death, conversion to laparotomy, laparoscopic repair, spontaneous resolution).

Results

Thirty-eight selected articles included 696,502 laparoscopies, with 1,575 injuries (0.23%), 126 (8%) of which involved blood vessels or hollow viscera (0.018% of all laparoscopies). Of the 98 vascular injuries, 8 (8.1%) were injuries to major retroperitoneal vessels. There were 34 other reported retroperitoneal injuries, but the authors were not specific as to which vessel was injured. Of the 28 injuries to hollow viscera, 17 were considered major injuries, i.e., 60.7% (0.0024% of the total cases assessed).

Conclusion

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.

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Authors and Affiliations

  1. Division of Operative Techniques and Experimental Surgery, Department of Surgery, Federal University of Sao Paulo, Rua Botucatu 740, Vila Clementino, São Paulo, SP, CEP 04023900, Brazil

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

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  1. João Luiz Moreira Coutinho Azevedo
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Correspondence to João Luiz Moreira Coutinho Azevedo.

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Azevedo, J.L.M.C., Azevedo, O.C., Miyahira, S.A. et al. Injuries caused by Veress needle insertion for creation of pneumoperitoneum: a systematic literature review. Surg Endosc 23, 1428–1432 (2009). https://doi.org/10.1007/s00464-009-0383-9

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  • DOI: https://doi.org/10.1007/s00464-009-0383-9

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