Laparoscopic Space Establishment: Veress Needle Relevant Anatomy and Procedures

One of the key steps in laparoscopic surgery is the establishment of pneumoperitoneum, which is done by insufflating carbon dioxide (CO2) to create enough space for surgical operations. The correct insertion and operation of the veress needle are crucial. This article will introduce the anatomical basis of pneumoperitoneum establishment and how to correctly use the veress needle to ensure safe and effective completion of laparoscopic surgery.

Anatomical Basis and Location Selection of the Veress Needle

The establishment of pneumoperitoneum is usually performed at the umbilicus because the anatomical structure there is relatively simple, with less subcutaneous fat, fewer blood vessels, and muscles. The structure of the umbilicus from the outside to the inside consists of: skin, anterior and posterior sheaths of the rectus abdominis muscle, parietal peritoneum, making this an ideal location for puncture. Using the veress needle effectively avoids excessive damage and bleeding during surgery, and the scars are less noticeable after surgery.

Choosing the umbilicus as the puncture point for the veress needle is based on its anatomical characteristics. It is the thinnest part of the entire abdominal wall and has the fewest blood vessels, reducing the risk of damaging vessels or organs. A clear understanding of the anatomical structure can greatly reduce the difficulty of pneumoperitoneum establishment and minimize post-operative complications.

Operating Steps and Precautions of the Veress Needle

Proper operation of the veress needle is the foundation of ensuring smooth establishment of pneumoperitoneum. Here are the steps and precautions to follow when using the veress needle:

Check the Veress needle

Before inserting the veress needle, thoroughly check its state to ensure the needle core is unobstructed, the bottom spring protection device works normally, and the needle sheath head is not bent or blunted. A well-functioning veress needle can effectively prevent erroneous judgment of force during puncture, thus reducing damage to intra-abdominal organs. Ensuring the normal operation of the instrument is the first step to safe operation; any oversight can increase surgical risks.

The puncture process of the Veress needle

After preparing the veress needle, first make a skin incision of about1cm at the umbilicus, which can be vertical, horizontal, or curved. Next, lift the abdominal wall and grip the veress needle using a pen-holding method. The thumb and forefinger holding the needle should be as close to the needle tip as possible to control the feeling of penetration and avoid over-penetration that could damage organs. The puncture angle should be around 45° to ensure that when penetrating the linea alba and peritoneum, two distinct resistances can be felt, which also serve as important signals to determine correct puncture.

At this time, insert the veress needle into the abdominal cavity for puncture, ensuring the abdominal wall is away from the intestines and omentum to avoid unnecessary damage to internal organs.

Test for successful puncture

After a successful puncture, several methods can be used to determine whether the veress needle has correctly entered the abdominal cavity. Common methods include:

• Syringe aspiration test: Attach a syringe containing normal saline to the veress needle. If no blood or intestinal fluid is withdrawn after aspiration, inject a small amount of saline to confirm the veress needle has entered the abdominal cavity correctly.

  
  

• Water drop test: Place a few drops of saline at the end of the veress needle. If negative pressure draws the water into the abdomen, it indicates the veress needle is correctly positioned.

  
  

• Initial insufflation test: Connect the veress needle to the CO2 tubing and inflate at low flow rate, observing the CO2 pressure gauge. If the pressure gradually rises from low to the set value, and the gas flow rate stabilizes, it indicates the veress needle puncture is successful.

These tests can help surgeons confirm the accuracy of pneumoperitoneum establishment, avoiding unnecessary complications. As a veress needle supplier, Boer Medical provides cost-effective and high-quality disposable veress needles. Welcome to consult and purchase.