The Experts below are selected from a list of 4884 Experts worldwide ranked by ideXlab platform
Nusret Aras - One of the best experts on this subject based on the ideXlab platform.
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Direct trocar insertion versus Veress Needle insertion in laparoscopic cholecystectomy
American journal of surgery, 1999Co-Authors: Mehmet Ali Yerdel, Kaan Karayalcin, Ayhan Koyuncu, Baris Akin, Cüneyt Köksoy, Ahmet Gökhan Türkçapar, Nezih Erverdi, Iskender Alacayir, Cihan Bumin, Nusret ArasAbstract:Abstract BACKGROUND: Direct insertion of the trocar is an alternative method to Veress Needle insertion for the creation of pneumoperitoneum. The safety of direct disposable shielded trocar insertion for the creation of pneumoperitoneum was assessed by comparing with Veress Needle insertion during laparoscopic cholecystectomy (LC). METHODS: One thousand five hundred patients undergoing LC with pneumoperitoneum were included in this study. In 470 patients the Veress Needle insertion technique was used, and in 1,030 patients direct trocar insertion technique was used. Patients having indications for open trocar insertion were excluded from the study. RESULTS: Complication rate was significantly higher in the Veress Needle group (14% versus 0.9%; P CONCLUSIONS: Our results suggest that with a lower complication rate, direct insertion of the disposable trocar is a safe alternative to Veress Needle insertion technique for the creation of pneumoperitoneum. Such an approach has further advantages such as less cost/instrumentation and rapid creation of pneumoperitoneum.
Lola Godinho - One of the best experts on this subject based on the ideXlab platform.
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Injuries caused by Veress Needle insertion for creation of pneumoperitoneum: a systematic literature review
Surgical Endoscopy, 2009Co-Authors: João Luiz Moreira Coutinho Azevedo, Otavio Cansanção Azevedo, Susana Abe Miyahira, Gustavo Peixoto Soares Miguel, Otávio Monteiro Becker, Octávio Henrique Mendes Hypólito, Afonso Cesar Cabral Guedes Machado, Wellington Cardia, Gilmara Aguiar Yamaguchi, Lola GodinhoAbstract:Background The aim of this study was to assess the prevalence, risks, and outcomes of injuries caused by the Veress Needle described in the literature. Methods Iatrogenic injuries caused by Veress Needle insertion during diagnostic or therapeutic laparoscopies in humans were researched, with no language restriction, in the Medline, Lilacs, Embase, Scielo, and Cochrane Library databases. The following words were combined: “Veress” or “insufflation Needle” or “pneumoperitoneum Needle,” and “complications” or “injuries” or “lesions.” The bibliographic references of the selected articles were also analyzed. We considered the following: (1) number of injuries described in the literature, (2) relationship between number of injuries and number of patients who underwent Veress Needle insertion in the studies that reported Veress Needle injury, (3) organs and structures injured (retroperitoneal vessels, digestive tract, and self-limited, minor injuries), and (4) outcome (death, conversion to laparotomy, laparoscopic repair, spontaneous resolution). Results Thirty-eight selected articles included 696,502 laparoscopies, with 1,575 injuries (0.23%), 126 (8%) of which involved blood vessels or hollow viscera (0.018% of all laparoscopies). Of the 98 vascular injuries, 8 (8.1%) were injuries to major retroperitoneal vessels. There were 34 other reported retroperitoneal injuries, but the authors were not specific as to which vessel was injured. Of the 28 injuries to hollow viscera, 17 were considered major injuries, i.e., 60.7% (0.0024% of the total cases assessed). Conclusion The insertion of the Veress Needle in the abdominal midline, at the umbilicus, poses serious risk to the life of patients. Therefore, further studies should be conducted to investigate alternative sites for Veress Needle insertion.
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injuries caused by Veress Needle insertion for creation of pneumoperitoneum a systematic literature review
Surgical Endoscopy and Other Interventional Techniques, 2009Co-Authors: João Luiz Moreira Coutinho Azevedo, Otavio Cansanção Azevedo, Susana Abe Miyahira, Gustavo Peixoto Soares Miguel, Otávio Monteiro Becker, Octávio Henrique Mendes Hypólito, Afonso Cesar Cabral Guedes Machado, Wellington Cardia, Gilmara S A Yamaguchi, Lola GodinhoAbstract:Background The aim of this study was to assess the prevalence, risks, and outcomes of injuries caused by the Veress Needle described in the literature.
Mehmet Ali Yerdel - One of the best experts on this subject based on the ideXlab platform.
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Direct trocar insertion versus Veress Needle insertion in laparoscopic cholecystectomy
American journal of surgery, 1999Co-Authors: Mehmet Ali Yerdel, Kaan Karayalcin, Ayhan Koyuncu, Baris Akin, Cüneyt Köksoy, Ahmet Gökhan Türkçapar, Nezih Erverdi, Iskender Alacayir, Cihan Bumin, Nusret ArasAbstract:Abstract BACKGROUND: Direct insertion of the trocar is an alternative method to Veress Needle insertion for the creation of pneumoperitoneum. The safety of direct disposable shielded trocar insertion for the creation of pneumoperitoneum was assessed by comparing with Veress Needle insertion during laparoscopic cholecystectomy (LC). METHODS: One thousand five hundred patients undergoing LC with pneumoperitoneum were included in this study. In 470 patients the Veress Needle insertion technique was used, and in 1,030 patients direct trocar insertion technique was used. Patients having indications for open trocar insertion were excluded from the study. RESULTS: Complication rate was significantly higher in the Veress Needle group (14% versus 0.9%; P CONCLUSIONS: Our results suggest that with a lower complication rate, direct insertion of the disposable trocar is a safe alternative to Veress Needle insertion technique for the creation of pneumoperitoneum. Such an approach has further advantages such as less cost/instrumentation and rapid creation of pneumoperitoneum.
João Luiz Moreira Coutinho Azevedo - One of the best experts on this subject based on the ideXlab platform.
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intraperitoneal pressure and volume of gas injected as effective parameters of the correct position of the Veress Needle during creation of pneumoperitoneum
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2009Co-Authors: João Luiz Moreira Coutinho Azevedo, Otavio Cansanção Azevedo, Susana Abe Miyahira, Otávio Monteiro Becker, Albino Augusto Sorbello, Otavio Hypolito, Dalmer Freire, Afonso Guedes, Glicia C AzevedoAbstract:Objective: The aim of this work was to establish reliable parameters of the correct position of the Veress Needle in the peritoneal cavity during creation of pneumoperitoneum. Methods: The Veress Needle was inserted into the peritoneal cavity of 100 selected patients, and a carbon-dioxide flow rate of 1.2L =min and a maximum pressure of 12mm Hg were established. Intraperitoneal pressure (IP) and the volume of gas injected (VG) were recorded at the beginning of insufflation and at every 20 seconds. Correlations were established for pressure and volume in function of time. Values of IP and VG were predicted at 1, 2, 3, and 4 minutes of insufflation, by applying the following formulas: IP ¼2.3083 þ0.0266 �time þ 8.3 �10 y5 �time 2 y2.44 �10 y7 �time 3 ; and VG ¼0.813 þ0.0157 �time. Results: A strong correlation was observed between IP and preestablished time points during creation of the pneumoperitoneum, as well as between VG and preestablished time points during creation of the pneumoperitoneum, with a coefficient of determination of 0.8011 for IP and of 0.9604 for VG. The predicted values were as follows: 1 minute ¼4.15; 2 minutes ¼6.27; 3 minutes ¼8.36; and 4 minutes ¼10.10 for IP (mm Hg); and 1 minute ¼1.12; 2 minutes ¼2.07; 3 minutes ¼3.01; and 4 minutes ¼3.95 for VG (L). Conclusions: Values of IP and VG at given time points during insufflation for creation of the pneumoperitoneum, using the Veress Needle, can be effective parameters to determine whether the Needle is correctly positioned in the peritoneal cavity.
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Injuries caused by Veress Needle insertion for creation of pneumoperitoneum: a systematic literature review
Surgical Endoscopy, 2009Co-Authors: João Luiz Moreira Coutinho Azevedo, Otavio Cansanção Azevedo, Susana Abe Miyahira, Gustavo Peixoto Soares Miguel, Otávio Monteiro Becker, Octávio Henrique Mendes Hypólito, Afonso Cesar Cabral Guedes Machado, Wellington Cardia, Gilmara Aguiar Yamaguchi, Lola GodinhoAbstract:Background The aim of this study was to assess the prevalence, risks, and outcomes of injuries caused by the Veress Needle described in the literature. Methods Iatrogenic injuries caused by Veress Needle insertion during diagnostic or therapeutic laparoscopies in humans were researched, with no language restriction, in the Medline, Lilacs, Embase, Scielo, and Cochrane Library databases. The following words were combined: “Veress” or “insufflation Needle” or “pneumoperitoneum Needle,” and “complications” or “injuries” or “lesions.” The bibliographic references of the selected articles were also analyzed. We considered the following: (1) number of injuries described in the literature, (2) relationship between number of injuries and number of patients who underwent Veress Needle insertion in the studies that reported Veress Needle injury, (3) organs and structures injured (retroperitoneal vessels, digestive tract, and self-limited, minor injuries), and (4) outcome (death, conversion to laparotomy, laparoscopic repair, spontaneous resolution). Results Thirty-eight selected articles included 696,502 laparoscopies, with 1,575 injuries (0.23%), 126 (8%) of which involved blood vessels or hollow viscera (0.018% of all laparoscopies). Of the 98 vascular injuries, 8 (8.1%) were injuries to major retroperitoneal vessels. There were 34 other reported retroperitoneal injuries, but the authors were not specific as to which vessel was injured. Of the 28 injuries to hollow viscera, 17 were considered major injuries, i.e., 60.7% (0.0024% of the total cases assessed). Conclusion The insertion of the Veress Needle in the abdominal midline, at the umbilicus, poses serious risk to the life of patients. Therefore, further studies should be conducted to investigate alternative sites for Veress Needle insertion.
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injuries caused by Veress Needle insertion for creation of pneumoperitoneum a systematic literature review
Surgical Endoscopy and Other Interventional Techniques, 2009Co-Authors: João Luiz Moreira Coutinho Azevedo, Otavio Cansanção Azevedo, Susana Abe Miyahira, Gustavo Peixoto Soares Miguel, Otávio Monteiro Becker, Octávio Henrique Mendes Hypólito, Afonso Cesar Cabral Guedes Machado, Wellington Cardia, Gilmara S A Yamaguchi, Lola GodinhoAbstract:Background The aim of this study was to assess the prevalence, risks, and outcomes of injuries caused by the Veress Needle described in the literature.
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Evaluation of the positioning of the tip of the Veress Needle during creation of closed pneumoperitoneum in pigs.
Acta cirurgica brasileira, 2006Co-Authors: João Luiz Moreira Coutinho Azevedo, Otavio Cansanção Azevedo, Albino Augusto Sorbello, Rodrigo Santa Cruz Guindalini, Cássio Edvan Paulino Da Silva, Gilmara Da Silva Aguiar, Francisco Julimar Correia De Menezes, Aline Delorenzo, Rubens Campana Pasqualin, Fábio Okutani KozuAbstract:PURPOSE: Erroneous punctures and insufflations are frequent with the use of the Veress Needle. Mistaken injections of gas in the preperitoneal space are not rare. The purpose of this research is to evaluate the correct positioning of the tip of the Needle during creation of pneumoperitoneum. METHODS: The Needle was inserted into the peritoneal cavity. Tests to assess the positioning of the Needle tip were carried out. Pressure, flow rate and volume were periodically recorded and the Needle was removed, being immediately reinserted into the right hypochondrium and placed in the preperitoneal space. RESULTS: The liquid flow test was always positive in the peritoneal cavity. No resistance to saline injection into the peritoneal cavity was observed, but increased resistance to saline injection into the preperitoneal space was observed in 45.5% of the cases. Some saline was recovered in 63.5% of the cases in the peritoneal cavity, and in 54.5% in the preperitoneal space. Saline drop test was positive in 66.6% of the cases in the peritoneal cavity and in 45.5% in the preperitoneal space. In the peritoneal cavity, initial pressure lower than 5 mm Hg was observed, and this pressure gradually increased during 123 seconds until reaching 15 mm Hg. In the preperitoneal space, initial pressure was 15 mm Hg. CONCLUSIONS: Aspiration, liquid flow and saline drop tests are important, whereas recovery test is inconclusive. Initial pressure of approximately 5 mm Hg indicates that the tip of the Needle is in the peritoneal cavity. The peritoneal cavity should hold ten times as much volume of gas as the preperitoneal space. The increase in pressure and volume in the peritoneal cavity can be predicted by statistics.
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Evaluation of tests performed to confirm the position of the Veress Needle for creation of pneumoperitoneum in selected patients: a prospective clinical trial
Acta cirurgica brasileira, 2006Co-Authors: Otavio Cansanção Azevedo, João Luiz Moreira Coutinho Azevedo, Gustavo Peixoto Soares Miguel, Albino Augusto Sorbello, Jorge Luis Wilson Junior, Antônio Cláudio De GodoyAbstract:PURPOSE: To evaluate tests performed to confirm the position of the Veress Needle inserted into the left hypochondrium for creation of pneumoperitonium. METHODS: One hundred patients were submitted to laparoscopic procedure with left hypochondrium puncturing. Needle positioning tests were evaluated. The aspiration test was considered positive when organic material was aspirated; the injection test was considered positive when no increased resistance to liquid injection was observed; the recovery test was considered positive when the liquid injected was not recovered; the saline drop test was considered positive when drops of saline in the syringe disappeared quickly; the initial intraperitoneal pressure test was considered positive when pressure levels were £ 8 mmHg. A positive aspiration test indicated iatrogenic injury, whereas a positive result in any of the other tests indicated that the tip of the Needle was correctly positioned in the peritoneal cavity. Sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of the tests were calculated by correlating results considered true positives (a), false positives (b), false negatives (c) and true negatives (d), according to the formulas: SE = [a/(a + c)] x 100; SP = [d/(b + d)] x 100; PPV = [a/(a + b)] x 100; NPV = [d(c + d)] x 100. RESULTS: With regard to the aspiration test, SE and PPV were not applicable, SP was 100% and NPV was 100%. With regard to the injection test, SE was 0%, SP was 100%, PPV was inexistent and NPV was 90%. Both recovery and saline drop tests yielded the following results: SE was 50%, SP was 100%, PPV was 100% and NPV was 94.7%. The initial intraperitoneal pressure test yielded the following results: SE, SP, PPV and NPV were 100%. CONCLUSIONS: When inserting the Veress Needle into the left hypochondrium, a negative aspiration test guarantees the absence of iatrogenic injury; the injection test is not reliable to determine incorrect Needle positioning, but it accurately detects correct Needle positioning; recovery and saline drop tests are not reliable to determine correct Needle positioning, but they accurately detect incorrect Needle positioning; the initial intraperitoneal pressure test is reliable to determine both correct and incorrect Needle positioning, and proved to be the most reliable of the tests analyzed.
Jean Gugenheim - One of the best experts on this subject based on the ideXlab platform.
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Laparoscopic entry techniques in obese patient: Veress Needle, direct trocar insertion or open entry technique?
Obesity surgery, 2014Co-Authors: Radwan Kassir, Pierre Blanc, Patrice Lointier, Olivier Tiffet, Jean-luc Berger, Imed Ben Amor, Jean GugenheimAbstract:Laparoscopy is a common procedure in bariatric surgery. Serious complications can occur during laparoscopic entry as reported by Ahmad et al. (Cochrane Database Syst Rev 15:2, 2012). Several techniques, instruments, and approaches to minimize the risk of injury (the bowel, bladder, major abdominal vessels, and an anterior abdominal wall vessel) have been introduced. These methods include the standard technique of insufflation after insertion of the Veress Needle, the open (Hasson technique), the direct trocar insertion, and optical trocar insertion. Furthermore, it is more difficult to perform in the obese patient, especially if the first trocar is not umbilical. This is because obese patients have a very thick abdominal wall (particularly in women) as well as a thick peritoneum. The aim of this article was to demonstrate the safety of various laparoscopic entry techniques in obese patient.
