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Updated: Mar 12, 2026
Direct Pressure Monitoring Accurately Predicts Pulmonary Vein Occlusion During Cryoballoon Ablation
Published on: February 26, 2013
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.
Background:
Safe establishment of pneumoperitoneum is essential in laparoscopic surgery because most access-related injuries occur during peritoneal entry. In Veress needle procedures, this step is performed blindly, and conventional verification tests are subjective and often unreliable. The negative pressure-based visualization (NPV) technique enables real-time confirmation of peritoneal entry using a saline column. We therefore developed a manometric modification (NPMV) and a four-forceps technique (NPMV4) to improve practicality and applicability in obese patients.
Methods:
This retrospective study included two cohorts: a standard-weight cohort of 475 patients undergoing laparoscopic groin hernia repair (243 NPMV, 232 NPV) and an obese cohort of 53 patients undergoing laparoscopic sleeve gastrectomy (33 four-forceps, 20 two-forceps). In the NPMV, the Veress needle was connected to an insufflator with a manometric display, and peritoneal entry was confirmed at a pressure of minus 2 mmHg or lower. Primary outcomes were pneumoperitoneum success and access-related complications; secondary outcomes included access time and puncture attempts.
Results:
In the standard-weight cohort, pneumoperitoneum success was 99% in both groups, with no differences in complications or puncture attempts. The NPMV group achieved a significantly shorter time to insufflation (median 1.0 vs 2.0 min, p < 0.001). In the obese cohort, the four-forceps group showed fewer failed entries (3% vs 15%) and significantly fewer puncture attempts (median 1.0 vs 3.5, p = 0.019), without increased gas-related complications.
Conclusion:
Replacing the saline column with a manometric display did not increase access-related complications and improved procedural efficiency. The NPMV4 technique further improved the reliability of laparoscopic access in obese patients. These stepwise modifications provide a simple, reproducible, and reliable approach to Veress needle access across diverse surgical populations.
