Veress needle

A Veress needle or Veres needle[1] is a spring-loaded needle used to create pneumoperitoneum for laparoscopic surgery. Of the three general approaches to laparoscopic access, the Veress needle technique is the oldest and most traditional.

Veress needle

History

The tool was first developed in 1932 by János Veres(s) (1903–1979), a Hungarian internist working with tuberculosis patients.[1][2] At the time, one of the mainstays of treatment was to collapse an infected lung and allow lesions to heal.[3] The needle was introduced as a safer technique to give patients such pneumothoraces. It was not until 1938, when he published his invention in the German literature, that the needle became more broadly known outside of Hungary.[4]

Raoul Palmer introduced the use of the Veress needle in laparoscopy to establish a pneumoperitoneum.[5]

Description

Modern needles are 12 to 15 cm long, with an external diameter of 2 mm. The outer cannula consists of a beveled needle point for cutting through tissues of the abdominal wall. A spring-loaded, inner stylet is positioned within the outer cannula. This inner stylet has a dull tip to protect any viscera from injury by the sharp, outer cannula. Direct pressure on the tip—as when penetrating through tissue—pushes the dull stylet into the shaft of the outer cannula. When the tip of the needle enters a space such as the peritoneal cavity, the dull, inner stylet springs forward. Carbon dioxide is then passed through the Veress needle to inflate the space, creating a pneumoperitoneum.[6]

Use

In a large survey of 155,987 gynecologic procedures and 17,216 general surgery procedures, the Veress needle technique was used in 78% of them. Gynecologists (81%) used the tool more often than general surgeons (48%) who are far more likely to use the open access technique.[7]

Iatrogenics

In different studies, it has been pointed out that for different laparoscopic surgery applications (such as cholecystectomy, groin hernia repairs and appendectomies) creating pneumoperitoneum by using a Veress needle is not always as safe and effective as other techniques (e.g. direct trocar insertion (DTI)).[8][9][10] However, some other prospective studies point out that there is no significant difference between the technique chosen and incidence of complications by inducing pneumoperitoneum using a Veress needle or the Hasson technique.[11][12] Between the complications associated to this instrument it can be found:

  • Injury to hollow viscous
  • Bleeding
  • Failure to achieve pneumoperitoneum
  • Prepneumoperitoneum
  • Biloma due to liver puncture.[13]
  • Vascular injury

See also

References
  1. Baskett, Thomas F. (2019). Eponyms and Names in Obstetrics and Gynaecology. Cambridge, UK: Cambridge University Press. p. 436.
  2. Szabó, István; László, Ádám (2004). "Veres Needle: In Memoriam of the 100th Birthday Anniversary of Dr János Veres, the Inventor". American Journal of Obstetrics & Gynecology. 191 (1): 352–3. doi:10.1016/j.ajog.2004.01.030. PMID 15295391.
  3. Wolfart W (1990). "Surgical treatment of tuberculosis and its modifications—collapse therapy and resection treatment and their present-day sequelae". Offentl Gesundheitswes. 52 (8–9): 506–11. PMID 2146567.
  4. Veress, János (1938). "Neues Instrument zur Ausführung von Brust- oder Bauchpunktionen und Pneumothoraxbehandlung". Deutsche Medizinische Wochenschrift. 64 (41): 1480–1481. doi:10.1055/s-0028-1123401.
  5. Palmer, R (1947). "Instrumentation et technique de la coelioscopie gynécologique". Gynécologie et Obstétrique. 46 (4): 420–31. PMID 18917806.
  6. Gould JC, Philip A. Principles and Techniques of Abdominal Access and Physiology of Pneumoperitoneum. In: Ashley SW. Scientific American Surgery. Decker Intellectual Properties; 2011.
  7. Molloy, David; Kaloo, Philip D.; Cooper, Michael; Nguyen, Tuan V. (2002). "Laparoscopic entry: A literature review and analysis of techniques and complications of primary port entry". The Australian and New Zealand Journal of Obstetrics and Gynaecology. 42 (3): 246–254. doi:10.1111/j.0004-8666.2002.00246.x. PMID 12230057.
  8. K. Theodoropoulou, MD,corresponding author D. R. Lethaby, MBBS, H. A. Bradpiece, FRCS, T. L. Lo, MBBS, and A. Parihar, MBBS (2008). "Direct Trocar Insertion Technique: an Alternative for Creation of Pneumoperitoneum". Journal of the Society of Laparoendoscopic Surgeons. 12 (2): 156–158. PMC 3016192. PMID 18435888.CS1 maint: multiple names: authors list (link)
  9. Yerdel MA, Karayalcin K, Koyuncu A, Akin B, Koksoy C, Turkcapar AG, Erverdi N, Alaçayir I, Bumin C, Aras N (1999). "Direct trocar insertion versus veress needle insertion in laparoscopic cholecystectomy". The American Journal of Surgery. 177 (3): 247–249. doi:10.1016/S0002-9610(99)00020-3. PMID 10219864.CS1 maint: multiple names: authors list (link)
  10. Prieto-Diaz-Chavez E, Medina-Chavez JL, Gonzalez-Ojeda A, Anaya-Prado R, Truzillo Hernandez B, Vasquez C. (Sep 2006). "Direct trocar insertion without pneumoperitoneum and the Veress needle in laparoscopic cholecystectomy: a comparative study". Acta Chirurgica Belgica. 106 (5): 541–544. doi:10.1080/00015458.2006.11679948. PMID 17168266.CS1 maint: multiple names: authors list (link)
  11. Dunne N, Booth MI, and Dehn TCB (2011). "Establishing pneumoperitoneum: Verres or Hasson? The debate continues". Annals of the Royal College of Surgeons of England. 93 (1): 22–24. doi:10.1308/003588411X12851639107557. PMC 3293265. PMID 21054924.CS1 maint: multiple names: authors list (link)
  12. Kumar S (2012). "Veress needle insertion through left lower intercostal space for creating pneumoperitoneum: Experience with 75 cases". Journal of Minimal Access Surgery. 8 (3): 85–89. doi:10.4103/0972-9941.97590. PMC 3401722. PMID 22837595.
  13. Segura-Sampedro JJ, Cañete-Gómez J, Reguera-Rosal J, Padillo-Ruiz FJ, Ramírez-Plaza CP (Jul 2015). "Unnoticed biloma due to liver puncture after Veress needle insertion". Annals of Medicine and Surgery. 4 (3): 238–239. doi:10.1016/j.amsu.2015.07.016. PMC 4624565. PMID 26587233.
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