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Abdominal surgery: General principles of access
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Nigel J. Hall, Katherine A. Barsness
The concept of the Veress needle* is that insufflation of the peritoneal cavity to a preset maximum pressure creates a safe space into which a trocar can then be inserted. While conceptually appealing, visceral injuries are equally as likely with Veress needle techniques as they are with other methods for initial and subsequent trocar placement. It is therefore advised that the method of access be done with the utmost care required, with the acknowledgment of the ever-present risk of injury to abdominal viscera from any means of laparoscopic access.
Vascular Complications of Urologic Surgery
Published in Kevin R. Loughlin, Complications of Urologic Surgery and Practice, 2007
The risk of vascular injury from the Veress needle during laparoscopy is relatively uncommon. Hurd et al. (7) concluded from a review of CT scans that the umbilicus is at or just cephalad to the aortic bifurcation and consistently located cephalad to the point where the left common iliac vein crosses the midline. The incidence of major vascular injury associated with laparoscopy is difficult to determine. Mintz’s survey of 100,000 laparoscopic procedures in France in the 1970s suggested that three major vascular injuries occurred for each 10,000 procedures (8). Parsons et al. (9) reported on 894 urologic laparoscopies at a single institution in 2004. The most common intra-operative complication was vascular injury with an incidence of 2.5%. In general the reported rate of major vascular injury from laparoscopy is thought to be between 0.5% and 2.5% (9–12).
Port placement for intraperitoneal chemotherapy
Published in Wim P. Ceelen, Edward A. Levine, Intraperitoneal Cancer Therapy, 2015
Lisa M. Landrum, Joan L. Walker
With port placement in a laparoscopic-assisted fashion, the original abdominal incision can be avoided, and the entire procedure can be completed under direct visualization from a right upper quadrant approach (Figures 16.2 through 16.5) [41,42]. A pneumoperitoneum is established with a Veress needle in the right upper quadrant, after appropriate gastric emptying. A 5 mm trocar is placed for the laparoscope, and the catheter is positioned under direct visualization. The catheter can then be introduced into the peritoneal cavity using a needle, followed by wire, followed by pull away sheath technique. Alternatively, a second 5 mm trocar is placed, and the catheter is passed down the trocar into the peritoneal cavity. The catheter is tunneled through the subcutaneous tissues, using a long tonsil or tunneling device to the site selected on the inferior thorax for the access port. The catheter should have been tailored to the appropriate length at both ends to avoid having any catheter perforations within the abdominal wall, or the catheter too long where it can reach the vagina [43], bladder [44] rectum [45], or any anastomosis sites and result in complications. All port sites should be closed to prevent leakage of fluid, ideally using a Carter–Thompson closure device and 0-vicryl sutures to reapproximate peritoneum and fascia. The interventional radiologist can also place IP catheters under CT or ultrasound guidance. One technique for successful placement by interventional radiology under conscious sedation has been described by Henretta and colleagues in 11 patients with advanced ovarian cancer [46].
Tumour markers and histopathologic features of ovarian endometriotic cysts
Published in Journal of Obstetrics and Gynaecology, 2021
Selcuk Selcuk, Mehmet Kucukbas, Nermin Koc, Cetin Cam, Enis Ozkaya, Ahmet Eser, Ates Karateke
Surgeries were performed by expert gynaecologists whose experiences in endoscopy ranged from 5-15 years using the same instruments and surgical technique. Laparoscopic cystectomy was carried out under video control through a subumbilical incision and two lower abdominal incisions using 5-mm scissors and grasping forceps. A Veress needle was inserted into the abdominal cavity to establish pneumoperitoneum. The cysts were freed from the adjacent tissues using blunt and sharp dissection. After aspiration of the cyst’s contents, the cyst capsule was stripped from the normal ovarian tissue with two atraumatic grasping forceps pulled in opposite directions; due to some adhesions to the surrounding ovarian tissue in several places, a sharp dissection with scissors was needed in most of the cases. The detached capsule was placed in a bag and removed from the abdominal cavity through the subumbilical incision. The remaining ovarian tissue was left unsutured after establishing haemostasis.
Simultaneous laparoscopic proctocolectomy (TaTME) and robot-assisted radical prostatectomy for synchronous rectal and prostate cancer
Published in Acta Chirurgica Belgica, 2019
Ben Gys, Karen Fransis, Guy Hubens, Sylvie Van den Broeck, Bart Op de Beeck, Niels Komen
The patient was placed in the Trendelenburg position at a 30° angle. Pneumoperitoneum was established using a Veress needle. Six trocars were used. The parietal peritoneum was incised over a length of 7 cm at the anterior surface of the pouch of Douglas. Seminal vesicles and vasa deferentia were isolated. Afterwards, an extrafascial, non-nerve sparing dissection was performed in an antegrade direction starting at the posterolateral surface of the prostate towards the prostatic apex. Identification of the vesicoprostatic junction was performed followed by transection of this junction while sparing the bladder neck. Next, dissection of the anterior surface of the prostate was completed with isolation of the apex and incision of the urethra. After freeing the whole prostate, the specimen was placed in an endobag. The anastomosis between bladder neck and urethra was performed using a modified Van Velthoven technique and a suprapubic catheter was placed.
Complications in robotic urological surgeries and how to avoid them: A systematic review
Published in Arab Journal of Urology, 2018
Rafael Rocha Tourinho-Barbosa, Marcos Tobias-Machado, Adalberto Castro-Alfaro, Gabriel Ogaya-Pinies, Xavier Cathelineau, Rafael Sanchez-Salas
Veress needle access, Hasson open technique and optical-access trocar are the most common access techniques. A Veress needle is a sharp instrument placed blindly through the abdominal wall and should be verified if it is working properly before its introduction. In pelvic procedures patients should remain in a neutral dorsal position during first trocar placement and the needle is passed at 45 ° (90 ° in obese patients) to avoid great vessel injury. Safety checks, aspiration/injection and lifting the abdominal wall upwards help to minimise the risk of complications. As opposed to Veress needle access, the Hasson open technique allows direct view of abdominal and pelvic structures during access. However, despite what some may think, a Cochrane review of laparoscopic entry techniques found no differences between open or Veress needle access complications [26].