Page 7 - Laparoscopic Journal - WJOLS

WJOLS
WJOLS

10.5005/jp-journals-10033-1244
Veress Needle for Port-site Closure
OriginaL articLe

Veress Needle for Port-site Closure

2
1 Balamurali Krishna Kotakala, RK Mishra

ABSTRACT Trocar site herniation is also associated with other
Port closure is essential after successful laparoscopic surgery to technical factors other than the port-site. Port location is
prevent incisional hernia. There are various devices like: fascial another factor. There are many reports suggesting that
closure needle, Cobbler’s needle and suture passer to close umbilical sites are at a greater risk of herniation when
10 mm ports in laparoscopic surgery. We have reported a novel compared to lateral port-sites. 1,7,8 This is due to weakness
technique for the closure of the ports after laparoscopic surgery.
Using this simple technique, all the ports are closed under vision, of the fascia and absence of supporting muscle in this
1,2
thus preventing port herniation by using simple Veress needle. area. Stretching or even extending the incision of a
Keywords: Laparoscopic port closure, Port closure technique, port-site during specimen extraction has a greater risk of
Veress needle. hernia development. 9,10 Factors like high body mass index
How to cite this article: Kotakala BK, Mishra RK. Veress (BMI) are patient-related risk factors that are associated
Needle for Port-site Closure. World J Lap Surg 2015;8(2):39-42. with TSH include. 8,11-13 Here it is related to the increased
Source of support: Nil intra-abdominal pressure and increased abdominal wall
thickness. 2,14 Studies show that wound infection is a
Conflict of interest: None
15
predisposing factor to hernia development. Therefore,
iNTRoduCTioN closure of fascia is necessary for umbilical ports, port-sites
that are stretched or enlarged for specimen retrieval, and
Minimal access surgery is a routine surgical practice trocar sites in obese patients.

due to its minimally invasive nature and associated There are a number of methods of port-site closure
1,2
advantages. It has a lot of advantages but not devoid of but there is no gold standard. Use of traditional sutu-
complications, one of the major concerned complication ring techniques are difficult due to blind closure of the
16
is the trocar site herniation (TSH). Trocar site herniation fascial defect. Varying degrees of success are achieved
is a serious complication often requiring emergency by modified hand suturing techniques. 17-19 Finding the
reoperation for repair. If unattended, TSH can lead to rectus sheath and suturing through the layers of a thicker
small bowel strangulation and incarceration. abdominal wall through a relatively small hole is challen-
The literature says that preventative measures should ging particularly in the obese. 13,16 In such cases, we need
be taken to avoid the occurrence of herniation at the port- special instruments for efficient closure of the port-site.
site. Fascial closure has been recommended as a means Veress needle is an instrument that is commonly used for
1,2
of TSH prevention. One study reported a statistically creating pneumoperitoneum. In this study, veress needle
higher frequency of hernias at 12 mm port-sites where has been used to close the port-site efficiently under vision.
the fascia was left open (8%) compared with those that AiM oF THE STudY
3
were closed (0.22%) following laparoscopy. There is a
general consensus that all port-sites greater than or equal To show Veress needle is a safe, efficient and cost-effective
to 10 mm should be closed due to an increased risk of tool for port-site closure.
herniation. 1,3,4 For smaller ports fascial closure may not HiSToRY oF VERESS NEEdLE
be necessary, except when manipulated extensively. 5,6
In 1938, Janos Veress of Hungary developed a specially
designed spring-loaded needle. Interestingly, Veress did
1,2 Consultant not promote the use of his Veress needle for laparoscopy
purposes. He used Veress needle for the induction of
1 Department of General Surgery, Kamala Nursing Home
Marripalem, Visakhapatnam, Andhra Pradesh, India pneumothorax.
But now Veress needle is the most important instru-
2 Department of Minimal Access Surgery, World Laparoscopy

Hospital, Gurgaon, Haryana, India ment today to create pneumoperitoneum.
Corresponding Author: Balamurali Krishna Kotakala PARTS oF VERESS NEEdLE
Consultant, Department of General Surgery, Kamala Nursing
Home, Marripalem, Visakhapatnam, Andhra Pradesh Veress needle consists of an outer cannula with a beveled
India, Phone: +91-9885509966, e-mail: drbalamuralikrishna@ needle point for cutting through tissues. Inside the can-
gmail.com
nula of veress needle is an inner stylet, stylet is loaded
World Journal of Laparoscopic Surgery, May-August 2015;8(2):39-42 39