Periumbilical veress needle pneumoperitoneum: technique and results in 2.126 cases

In laparoscopic surgery, a pneumoperitoneum is generally created either by direct puncture (Veress needle technique) or by the open (Hasson) technique. Some surgeons predominantly use direct access, reserving open access for selected patients; others consider the Veress needle as carrying an unacceptable risk of intestinal or vascular injury and consequently use only the Hasson technique. The database containing records of all abdominal laparoscopic operations performed in our institution was reviewed; over the period from June 1991 to December 2001 a total of 2,126 laparoscopic operations were performed, consisting in 1,457 (68.5%) cholecystectomies, 392 (18.4%) appendectomies, 177 (8.3%) varicocelectomies, 65 (3%) operations on the uterus and ovaries, 6 (0.2%) groin hernia repairs, 6 (0.2%) fundoplications, 3 (0.1%) ileo-colic resections for right colon cancer, and 20 (1.3%) diagnostic laparoscopies. The direct puncture technique was used in 100% of cases. The time needed up to connection of the video camera averaged 4-7 minutes. Twelve laparoscopic cholecystectomies were converted, with a conversion rate of 0.5%. Four patients were re-operated on, two for bleeding from the gallbladder fossa and two because of small bowel perforation caused by electrocautery. None of the patients sustained any clinically apparent vascular or bowel injury as a result of the blind access. There were no cases of preperitoneal or omental air insufflation. The mortality was nil. The authors describe their technique for gaining access to the abdominal cavity by direct puncture and conclude that properly performed Veress needle insertion is less invasive, safe and perfectly feasible in all patients.