A simple, safe technique for placement of the veress needle and trocar in laparoscopy

Hilgers TW

doi:10.1089/lps.1992.2.189

A simple, safe technique for placement of the veress needle and trocar in laparoscopy

Hilgers TW

Published August 1992 Journal of Laparoendoscopic Surgery, 2(4), 189-192

DOI 10.1089/lps.1992.2.189 PMID 1388074

RRM Academy Synopsis

No entry failed in 243 laparoscopies using rectus fascia clamps

In this 1992 case series of 243 consecutive laparoscopy patients, no insufflation failed when clamps held the abdominal wall fascia during needle insertion. Most patients had the surgery for infertility or other reproductive problems. The clamps lift the abdominal wall. Then the surgeon places the needle and trocar.

Key Findings

The series included 243 consecutive patients having diagnostic laparoscopy, mostly for reasons tied to infertility or other reproductive disorders.
All 243 veress needle insertions were successful (100.0%). The author reports no failed insufflations and no preperitoneal emphysema.
195 patients (80.2%) needed one attempt at insertion, and 47 (19.3%) needed 2 to 4 attempts.
In one patient with very thin anterior rectus fascia, the clamps pierced into the abdominal cavity during the search for the fascia. The author reports no bowel or other organ injury.

Interpretation

The case series followed 243 consecutive laparoscopy patients. Clamps held the abdominal wall fascia before the needle and trocar went in. The technique began with patients who were hard to laparoscope, including obese patients. Surgeons later extended it more broadly. The findings support larger studies of this entry technique.

RRM Context

Laparoscopy lets surgeons see and treat pelvic disease such as endometriosis, and entry is its first step. The author wrote from the Pope Paul VI Institute, where NaProTechnology surgery was developed. The paper describes one practice detail from that tradition.

Our editorial summary of this paper, not the article's abstract.

Abstract

A simple technique of placing two Kocher clamps on the anterior rectus fascia for the elevation of the anterior abdominal wall during the insertion of the veress needle and the laparoscopic trocar is described in 243 consecutive patients. There were no failed insufflations during this study and no cases of preperitoneal emphysema. The technique is simple to use and adds safety to a basically blind procedure.

Thomas W Hilgers

Tom Hilgers, T Hilgers

PMID 1388074 1388074 DOI 10.1089/lps.1992.2.189 10.1089/lps.1992.2.189 Hilgers et al. 1992, Hilgers 1992

Keywords

Abdominal Muscles/surgery, Humans, Laparoscopy/methods

A simple, safe technique for placement of the veress needle and trocar in laparoscopy

No entry failed in 243 laparoscopies using rectus fascia clamps

Key Findings

Interpretation

RRM Context

Abstract

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Keywords