Renal Hilum Injury with Veress Needle

Since the advent of laparoscopy, the ideal first-port entry technique has not yet been determined. Use of the Veress needle at Palmer's point, although safe in practice under skilled physicians, is not without risk of complications.

A female patient with prior abdominal surgeries underwent a laparoscopic surgery for a nonmalignant indication. Intraoperative complications included hemodynamic instability and gross hematuria. The patient was ultimately stabilized, and imaging after the case revealed a hematoma formation around the left kidney with evidence of renal hilar injury.

The laparoscopic surgeon must be aware that blind Veress needle entry has inherent risk for injury of retroperitoneal structures including the renal system. Particularly if hemodynamic instability is noted after abdominal entry at any site, physicians should have a low threshold for investigation, including by laparotomy if necessary.