An evaluation of four tests used to ascertain Veres needle placement at closed laparoscopy

Abstract

Study objective: To determine the reliability of four commonly used tests to confirm the placement of the Veres needle during closed laparoscopy and their ability to determine other complications of entry.

Design: A prospective observational study (Canadian Task Force classification II-2).

Setting: A university-affiliated teaching hospital in Sydney, Australia.

Patients: Three hundred forty-five women undergoing closed laparoscopy using Veres needle peritoneal insufflation.

Interventions: The double click test, the hanging drop test, the aspiration test, and the initial five pressures at the time of insufflation following Veres needle placement were assessed for their sensitivity, specificity, and positive and negative predictive values for correct intraperitoneal placement of the needle and the presence or absence of any complication such as preperitoneal insufflation, omental emphysema, or visceral injury.

Measurements and main results: Complications occurred in 65 (18.8%) of 345 women, with preperitoneal insufflation in 19 (5.5%) of the 345, a superficial gastric injury in 1 (0.3%), and omental emphysema in 45 (13%). There was poor sensitivity and positive predictive values for preinsufflation tests. The first five pressures after commencement of insufflation were a sensitive predictor (79%) of complications, particularly preperitoneal insufflation (100% sensitivity for this complication). When two or more passes of the Veres were required, there was a significantly greater chance of preperitoneal insufflation (chi2 = 20.5, p <.0001). Preperitoneal insufflation was not reported when the first five successive insufflation pressures were less than 10 mm Hg.

Conclusions: The double click, aspiration, and hanging drop tests provide very little useful information on the placement of the Veres needle at the time of closed laparoscopy. The initial gas pressures provide considerable information on the placement of the Veres needle, in particular the likelihood of preperitoneal insufflation. We conclude that the initial gas pressure is the only valuable measure to reflect correct intraperitoneal Veres needle placement.