Veress needle insertion through left lower intercostal space for creating pneumoperitoneum: Experience with 75 cases

Abstract

Context: Veress needle insertion (VNI) at sub-umbilical fold (SUF) midline is associated with serious intra-abdominal injuries.

Aim: The aim of this study has been to evaluate the safety and efficacy of lower left intercostal space (LICS) for VNI.

Settings and design: This prospective observational study was conducted in three parts in Surgery-II, Department of Surgery, GTBH-UCMS, Delhi.

Materials and methods: In part one, skin fold thickness (SFT) was measured in 32 patients at SUF, LICS, right iliac fossa (RIF) and Palmer's point. As part two, in these patients, VNI was carried out from LICS under laparoscopic guidance. As part three, same technique of VNI was employed in 43 patients with suspected intra-abdominal adhesions undergoing laparoscopy for various reasons. Observations were made regarding ease of insertion, attempts needed for successful entry, loudness or clarity of give-way feeling of Veress needle, intra-abdominal bleeding at point of emergence of Veress needle, hemopneumothorax, bowel or vascular injury.

Statistical analysis used: SFT was expressed as mean (SD), and one-way ANOVA followed by Tukey's test were employed to find the statistical significance.

Results: SFT at LICS was significantly less as compared to SUF and Palmer's point. VNI at LICS was easy to carry out; it could be successfully done in first attempt in all patients, and was associated with very clear and loud give-way feeling. There were no instances of intra-abdominal bleeding at point of emergence of Veress needle, hemopneumothorax, bowel or vascular injury.

Conclusions: VNI at LICS as described here is safe and effective.

Keywords: Abdominal entry; laparoscopy; veress needle insertion.

Figure 1

Outside view showing Veress needle insertion through LICS just lateral to midclavicular line

Figure 2

Veress needle lying safely in peritoneal cavity after insertion through LICS