title: Direct needle insufflation for pneumoretroperitoneum: anatomic confirmation and clinical experience.
abstract: OBJECTIVE
  The feasibility and safety of direct needle insufflation to create pneumoretroperitoneum was assessed by an imaging study and clinical experience.
  
  
  METHODS
  A total of 10 patients without previous retroperitoneal surgery or diseases received computed tomography scans of the retroperitoneum 2 cm above the iliac crest. Distances between quadratus lumborum and colon (Q-C distance) were measured in the supine and lateral positions. Changes of Q-C distance were calculated when the patient was changed from the supine to the lateral position. Operative charts on 38 retroperitoneoscopic procedures were collected prospectively to assess complications related to direct needle insufflation, which was performed by inserting a 14 G Veress needle blindly along the posterior axillary line 2 cm above the iliac crest.
  
  
  RESULTS
  Q-C distance increased from 8.7 to 27.3 mm (left side) and 4.6 to 18.1 mm (right side) when the patient was changed from the supine to the lateral position, both P values < 0.05. An average distance of 23 mm between colon and quadratus lumborum was found when patients were lying laterally. The misplacement of a Veress needle was encountered in 1 patient, in which a prefascia insufflation resulted in conversion of the endoscopic procedure. Needle puncture caused no visceral or great vessel injury.
  
  
  CONCLUSIONS
  Significant anterior movement of the colon was found when patients were changed from the supine to the lateral position. It provided a window for inserting the Veress needle blindly into the retroperitoneum. The high success rate (97%) and low complication rate of direct needle insufflation were found in actual clinical applications. We considered needle insufflation a safe and effective method of establishing a pneumoretroperitoneum for any retroperitoneoscopic procedure.
authors.affiliation: Department of Surgery, Veterans General Hospital-Taipei, National Yang-Ming University, School of Medicine, Taiwan, Republic of China.
authors.forename: A W
authors.initials: AW
authors.lastname: Chiu
authors.forename: K K
authors.initials: KK
authors.lastname: Chen
authors.forename: J H
authors.initials: JH
authors.lastname: Wang
authors.forename: W J
authors.initials: WJ
authors.lastname: Huang
authors.forename: L S
authors.initials: LS
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005547:Foreign Bodies / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007327:Insufflation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016602:Needlestick Injuries / Q000209:etiology; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D011187:Posture; D011446:Prospective Studies; D012187:Retroperitoneal Space; D013352:Subcutaneous Emphysema / Q000209:etiology; D014057:Tomography, X-Ray Computed