Establishing Pneumoperitoneum: Do You Use Veress Needle or Primary Trocar?

Introduction to veress needle

A veress needle is a clinical medical device used for abdominal puncture, consisting of a veress needle, a catheter needle, and a handle. The veress needle has a spring protection device inside. When puncturing the abdominal wall, the needle core retracts into the needle sheath when encountering resistance. The pointed tip of the needle sheath can penetrate the abdominal wall. When the needle sheath punctures the peritoneum and enters the abdominal cavity, the abdominal cavity is filled with carbon dioxide gas, and the resistance disappears. The needle core pops out of the needle sheath under the action of the spring, making the front end of the veress needle blunt to avoid damaging the organs in the abdominal cavity.

Puncture with the veress needle is the first and most dangerous step in starting laparoscopic surgery. Data shows that more than half of the complications of laparoscopic surgery are related to the veress needle and the first puncture. This is easily understood, as only this step cannot be completed under the monitoring of the laparoscope. Therefore, paying attention to the various details of the veress needle puncture can greatly enhance the safety of the operation.

Use of the veress needle in creating pneumoperitoneum

As we all know, minimally invasive surgery is the direction and goal of surgical development. With the popularization of minimally invasive techniques, there will be more and more laparoscopic surgery and fewer open surgeries. The indispensable step in each laparoscopic surgery is to first create pneumoperitoneum, and then perform subsequent operations. The pneumoperitoneum in laparoscopic surgery has three methods: Veress needle method, direct cannula puncture method, and open method.

veress needle puncture method:

Make a 1.2cm skin incision in the abdomen before creating pneumoperitoneum. The surgeon and assistant use a towel clamp to lift the abdominal wall, and the surgeon rotates and exerts force on the wrist to directly puncture the cannula sheath into the abdominal cavity. Generally, there is a sense of dropping. After pulling out the drill core, the puncture instrument is pushed forward another 1 cm before starting to inflate. Insert the endoscope to observe whether the puncture sheath has entered the abdominal cavity before starting to inflate. Then insert the laparoscope and perform routine examination to ensure that there is no damage to the internal organs and tissues around the puncture hole.

Advantages of the veress needle:

It simplifies the puncture procedure and shortens the time for creating artificial pneumoperitoneum.

It reduces the probability of abdominal organ damage by eliminating one blind abdominal wall puncture operation.

Precautions for using the veress needle:

General anesthesia is preferred to keep the abdominal muscles fully relaxed and to prevent organ damage.

When puncturing with the veress needle, try to lift the abdominal wall as high as possible, use the wrist to exert force evenly and slowly, rotate it into the abdominal cavity, and avoid excessive force.

For patients with a history of abdominal surgery, the puncture hole should be chosen more than 3cm away from the incision scar.