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Stepwise evolution and clinical applicability of negative pressure-based manometric visualization for reliable Veress
Masanori Sato1, Kakeru Torii2,3, Yoshihiro Hiramatsu2,4
1Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Chuouku, Hamamatsu, Shizuoka, 431-3192, Japan. msnrsato@hama-med.ac.jp.
Surgical Endoscopy
|March 10, 2026
Summary
This study introduces manometric (NPMV) and four-forceps (NPMV4) techniques for safer laparoscopic surgery. These methods improve Veress needle access reliability, especially in obese patients, by enhancing procedural efficiency and reducing complications.
Area of Science:
- Minimally Invasive Surgery
- Surgical Technology
- Patient Safety
Background:
- Laparoscopic surgery relies on safe pneumoperitoneum establishment.
- Veress needle use for peritoneal entry is often blind, with unreliable verification methods.
- Negative pressure-based visualization (NPV) offers real-time confirmation, but modifications can enhance practicality.
Purpose of the Study:
- To develop and evaluate manometric modifications (NPMV) and a four-forceps technique (NPMV4) for Veress needle access.
- To improve the safety, efficiency, and applicability of laparoscopic procedures, particularly in obese patients.
- To reduce access-related injuries during peritoneal entry in laparoscopic surgery.
Main Methods:
- Retrospective study comparing NPMV and NPV techniques in standard-weight patients (n=475) for hernia repair.
- Evaluation of a four-forceps (NPMV4) versus two-forceps technique in obese patients (n=53) for sleeve gastrectomy.
- Peritoneal entry confirmed via manometric display at ≤ -2 mmHg for NPMV; outcomes included success rates, complications, access time, and puncture attempts.
Main Results:
- NPMV demonstrated a significantly shorter time to insufflation (1.0 vs 2.0 min) in standard-weight patients, with comparable success rates (99%) and complications.
- The NPMV4 technique in obese patients resulted in fewer failed entries (3% vs 15%) and reduced puncture attempts (median 1.0 vs 3.5).
- No increase in gas-related complications was observed with the modified techniques.
Conclusions:
- Replacing saline columns with manometric displays enhances procedural efficiency without increasing access-related complications.
- The NPMV4 technique significantly improves laparoscopic access reliability in obese patients.
- These stepwise modifications offer a simple, reproducible, and reliable approach to Veress needle access for diverse surgical populations.
