Veress Needle UWELL

The Veress Needle is a sterile, spring-loaded, single-use device designed to safely, simply, and effectively create pneumoperitoneum before trocar placement by insufflating carbon dioxide into the abdominal cavity. Common techniques for creating pneumoperitoneum include the Veress needle technique (closed entry) and the Hasson technique (open entry).

The umbilicus is the preferred site for entry because there is minimal subcutaneous tissue, and the fascial layers are fused at the linea alba. There are no major structures in this area, and it provides the shortest distance to the abdominal cavity. In a patient with a normal BMI, the needle is inserted at a 45-degree angle at the umbilicus to avoid the bifurcation of the major blood vessels. However, in a patient with a high BMI, a 90-degree angle is used because the umbilicus is located more caudally in relation to the vascular bifurcation.

Palmer’s point is an alternative site for needle entry, located 2 cm below the left costal margin at the midclavicular line. This site is selected in patients with a previous midline laparotomy, pelvic pathology extending to or above the umbilicus, very thin patients, very obese patients, or after multiple unsuccessful attempts at umbilical entry.

The Veress needle is always inserted at a 90-degree angle at Palmer’s point, regardless of BMI. Once pneumoperitoneum has been established, the trocar can be inserted. Alternatively, an optical trocar can be used, allowing the surgeon to visualize the fascia, rectus muscles, and peritoneum during entry into the abdominal cavity.

Lateral ports can be placed in the left or right lower quadrants, approximately two fingerbreadths medial and two fingerbreadths above the anterior superior iliac spines. When placing lateral ports, care should be taken to avoid the major superficial vessels and the deep inferior epigastric arteries in the anterior abdominal wall. This can be achieved by transilluminating the skin or by visualizing the abdominal wall using a laparoscope.

An additional safety check is to ensure that there is no significant bleeding when injecting the local anesthetic at the intended port site. The laparoscopic Veress needle offers several advantages compared with conventional open surgery or other laparoscopic techniques.