Laparoscopic Access Technique using Veress Needle | Step-by-Step Guide & Troubleshooting Tips скачать в хорошем качестве

Laparoscopic Access Technique using Veress Needle | Step-by-Step Guide & Troubleshooting Tips

Laparoscopic Access Technique using Veress Needle | Step-by-Step Guide & Troubleshooting Tips The Veress needle is typically the first instrument used during laparoscopic procedures. It was invented in 1939 by Dr. János Veres, a Hungarian pulmonologist, originally to create artificial pneumothoraces for treating tuberculosis. #laparoscopysurgery #laparoscopictechniques #laparoscopicinsights Let’s explore the commonly used Veress needles: reusable and disposable. Reusable Veress Needle Design: The reusable Veress needle features a sharp outer tip with a blunt inner stylet. The stylet has a hole at its distal end, enabling safe operation. Mechanism: As the needle is pushed through the skin, the blunt stylet retracts, exposing the sharp outer tip to cut through tissue. Once the needle crosses the peritoneum and enters the abdomen (due to a loss of resistance), the sharp tip is retracted, and the blunt stylet extends to protect underlying structures. This spring-loaded mechanism ensures safety during abdominal entry. Parts: Spring Mechanism: Located within the needle’s body and accessible for cleaning. Luer Lock Connection: Used to attach the CO₂ tubing for pneumoperitoneum. Stop Valve: Controls gas flow. Turning it 90° cuts the gas supply, while aligning it parallel to the needle allows gas to flow freely. Disposable Veress Needle Design and Features: Similar to the reusable version, with a sharp outer needle and a blunt inner stylet. An indicator ring shows the needle’s status: Red: Indicates the needle is within tissue. Green: Confirms entry into the abdominal cavity. Additional Features: Detachable components for cleaning and inspection. A ball indicator to monitor gas flow. Sizes of Veress Needles Standard needles have an outer diameter of 2 mm (14 gauge) and lengths ranging from 70 mm to 120 mm. Longer needles are available for bariatric surgeries or patients with a thicker abdominal wall. Steps for Veress Needle Insertion Skin Incision: Make a small nick (2–3 mm) near the umbilicus (upper or lower edge) or even within it for cosmetic reasons. Needle Insertion: Insert the needle at a 45° angle, aiming between the iliac vessels, not towards the aorta. Hold the needle like a pen and push it gently while observing the indicator ring. Feel for two clicks: First Click: Piercing the fascia. Second Click: Piercing the peritoneum. Tests to Confirm Proper Placement: Aspirate Test: Attach a syringe (10 ml) filled halfway with saline. Aspirate to ensure no blood or bowel content is drawn. Saline Injection Test: Inject 2–3 ml of saline. If it flows without resistance and doesn’t return, the needle is in the abdominal cavity. Suction Test: Lift the abdomen slightly and observe if the saline is sucked in, confirming free space. Gas Insufflation: Connect the CO₂ tubing to the needle and open the stop valve to begin insufflation. Monitor intra-abdominal pressure. It should remain below 7 mmHg initially. If pressure is higher, adjust the needle’s position. Alternative Entry Site: If umbilical entry fails, consider Palmer’s point (below the left costal margin at the midclavicular line). Post-Insertion Checks Ensure uniform abdominal distension during insufflation. Localized bulging suggests improper placement. Look for a loss of liver dullness, indicating successful pneumoperitoneum. Routine Veress Needle Maintenance Reusable Needles: Test the spring mechanism by pressing the needle tip to ensure smooth retraction and extension. Inspect for blockages by flushing saline through the needle. Check for leaks by plugging the outlet and applying moderate pressure. Disposable Needles: Replace if any leaks are detected. This guide covers the basics of Veress needle usage and troubleshooting. For further clarification, watch our instructional video and subscribe for more informative content.