Method of Using Veress Needle

Veress needle puncture is the first step in the official start of laparoscopic surgery, and it is also the most dangerous step. The data show that, among the complications of laparoscopic surgery, the complications related to the veress needle and the first puncture account for more than half. It is easy to understand that only this step in the laparoscopic operation cannot be completed under the surveillance of the laparoscope. Therefore, paying attention to the details of the veress needle puncture is of great benefit to improving the safety of the operation.

1. The use of veress needles

The veress needle is a needle-like structure with a valve at the back of one end. The gas tube of the carbon dioxide cylinder is connected here during pneumoperitoneum operation. The tip of the veress needle is not very sharp, but blunt, which is very good. It is designed to protect those who need to perform operations such as surgeons or nurses. Although the veress needle is blunt, when it touches the skin and pierces it firmly, the needle will pop out, forming a puncture needle, so that as long as it touches the skin and then applies force, the needle will pop out and pierce slowly The skin, muscle layer and serosa layer, and then reach the abdominal cavity. If you have experience in this operation, you can judge whether it reaches the abdominal cavity by hand.

After reaching the abdominal cavity, it is necessary to stop continuing to insert it immediately, because the space and space in the abdominal cavity are relatively small, and continued insertion will damage the internal organs. After entering the abdominal cavity, a pneumoperitoneum tube should be connected for ventilation. The surgeon or nurse pats the patient's abdomen, and you can see that the abdomen has obvious bulge. When the bulge reaches a certain level, it can be inserted. This is the role of the veress needle.

2. Veress needle insertion method

Those with strong hands can directly grab the abdominal wall with the left hand after incising the skin, and insert the needle into the abdominal cavity with the right hand. The common method is to use two towel forceps to clamp the skin on the left and right sides of the puncture port and lift it up to keep the abdominal wall away from the bowel and omentum. Then use a small sharp knife to make an 8-10mm incision at the puncture site. The left hand of the main knife lifts the towel forceps, the right hand holds a pen (writing brush) to hold the needle handle of the veress needle, and the wrist is close to the abdominal wall for support, and the veress needle is slowly inserted vertically into the abdominal cavity. There are usually two breakthrough sensations during the insertion process, when the veress needle passes through the abdominal wall fascia and the peritoneum. If the peritoneum is soft and elastic, the second breakthrough is often not obvious.

3. Selection of veress needle puncture location

The first thing to pay attention to when the veress needle use for puncture is the choice of the puncture hole. The choice of puncture hole depends on many factors, such as the size of the uterus, the size of the surgery, the thickness of the abdominal wall, and the surgical scar.

(1) In the case of tubo-ovarian surgery, puncture at the umbilicus can be selected.

(2) The puncture hole and lens can be placed 4-6 cm above the umbilicus during the resection of the larger uterus, the operation of the huge adnexal cyst or the lymph node dissection.

(3) If the patient is not tall and the umbilical-pubic distance is short, a supraumbilical incision is also required.

(4) The puncture needs to avoid surgical scars as much as possible and avoid damage to the intestinal tube adhered to the abdominal wall.