title: Is it necessary to lift the abdominal wall when preparing a pneumoperitoneum? A randomized study.
abstract: BACKGROUND
  In order to create a pneumoperitoneum with the Veress needle, it is generally advocated that the abdominal wall should be lifted. Lifting is aimed at increasing the distance between the abdominal wall and the intraabdominal structures. This study was conducted to compare lifting (L) and nonlifting (NL) of the abdominal wall.
  
  
  METHODS
  All patients scheduled for laparoscopic surgery without previous abdominal surgery or morbid obesity were included in the study group. The number of attempts needed for proper positioning of the needle was assessed.
  
  
  RESULTS
  A total of 150 patients were randomized. There were no complications. The number of attempts needed for correct positioning of the Veress needle was significantly higher in the L group than in the NL group (31 of 75 vs nine of 75, p < 0.001). The body mass index (BMI) of patients in whom peritoneal entry needed more than one puncture was significantly higher than the BMI of patients with immediate proper placement (28.3 vs 24.7 kg/m(2), p < 0.05).
  
  
  CONCLUSIONS
  Abdominal wall lifting is not necessary.
authors.affiliation: Department of General Surgery, St. Clara Hospital, Olympiaweg 350, 3078 HT Rotterdam, The Netherlands.
authors.forename: J W
authors.initials: JW
authors.lastname: Briel
authors.forename: P W
authors.initials: PW
authors.lastname: Plaisier
authors.forename: W S
authors.initials: WS
authors.lastname: Meijer
authors.forename: J F
authors.initials: JF
authors.lastname: Lange
mesh_terms: D000009:Abdominal Muscles; D000293:Adolescent; D000328:Adult; D000368:Aged; D001062:Appendectomy / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000379:methods*