title: Effect of body habitus and parity on the initial Veres intraperitoneal CO2 insufflation pressure during laparoscopic access in women.
abstract: OBJECTIVE
  Since most gynecologists use the Veres/trocar entry, and because the Veres intraperitoneal (VIP) pressure appears to be the most reliable indicator of correct Veres needle placement, the objective of this study was to determine the effect of height, weight, body mass index (BMI), parity, and age on the initial Veres intraperitoneal CO2 insufflation pressure during laparoscopic access in women.
  
  
  METHODS
  Prospective observational cohort study (Canadian Task Force classification II-1).
  
  
  METHODS
  University affiliated teaching hospital.
  
  
  METHODS
  We prospectively collected data on 356 women undergoing laparoscopy for a variety of indications by the senior author (G.A.V.). The median and (range) for height, weight, BMI, parity, and age were 1.64 m (1.45-1.85 m), 65 kg (40-120 kg), 24.3 kg/m2 (16-47 kg/m2), 1 (0-5) and 34 years (18-87 yrs), respectively.
  
  
  METHODS
  Under general endotracheal anesthesia including muscle relaxants and with the patient in appropriate stirrups in the horizontal position, a nondisposable Veres needle was inserted at the umbilicus or left upper quadrant (Palmer's point) with CO2 flowing at 1 L/min. The initial Veres intraperitoneal insufflation pressure was recorded once the Veres needle was believed to be in the peritoneal cavity.
  
  
  RESULTS
  The mode and the median VIP pressure was 4 mm Hg with a range of 2 to 10 mm Hg. With multivariate analysis, the VIP pressure correlated positively with the weight (r = 0.518, p <.001) and BMI (r = 0.545, p <.001) and negatively with the parity (r = -0.179, p <.001) of women. The correlation of the VIP pressure with height and age was r = 0.029 (p = .591) and r = -0.044 (p = .411), respectively.
  
  
  CONCLUSIONS
  A VIP pressure < or =10 mm Hg indicates intraperitoneal placement of the Veres needle. The VIP pressure correlates positively with the weight and BMI and negatively with the parity of women. There is no correlation of the VIP pressure with women's height and age.
authors.affiliation: St. Joseph's Health Care Department of Obstetrics and Gynecology, The University of Western Ontario, London, Ontario, Canada. george.vilos@sjhc.london.on.ca
authors.forename: Angelos G
authors.initials: AG
authors.lastname: Vilos
authors.forename: George A
authors.initials: GA
authors.lastname: Vilos
authors.forename: Basim
authors.initials: B
authors.lastname: Abu-Rafea
authors.forename: Jackie
authors.initials: J
authors.lastname: Hollett-Caines
authors.forename: Mohammad
authors.initials: M
authors.lastname: Al-Omran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001823:Body Composition; D015992:Body Mass Index; D002245:Carbon Dioxide; D015331:Cohort Studies; D005260:Female; D005831:Genital Diseases, Female / Q000175:diagnosis / Q000601:surgery; D006784:Hospitals, Teaching; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D010298:Parity; D011028:Pneumoperitoneum, Artificial / Q000295:instrumentation / Q000379:methods*; D011247:Pregnancy; D011312:Pressure; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity
chemical_list: D002245:Carbon Dioxide