Injuries caused by Veress needle insertion for creation of pneumoperitoneum: a systematic literature review.
BACKGROUND
The aim of this study was to assess the prevalence, risks, and outcomes of injuries caused by the Veress needle described in the literature.


METHODS
Iatrogenic injuries caused by Veress needle insertion during diagnostic or therapeutic laparoscopies in humans were researched, with no language restriction, in the Medline, Lilacs, Embase, Scielo, and Cochrane Library databases. The following words were combined: "Veress" or "insufflation needle" or "pneumoperitoneum needle," and "complications" or "injuries" or "lesions." The bibliographic references of the selected articles were also analyzed. We considered the following: (1) number of injuries described in the literature, (2) relationship between number of injuries and number of patients who underwent Veress needle insertion in the studies that reported Veress needle injury, (3) organs and structures injured (retroperitoneal vessels, digestive tract, and self-limited, minor injuries), and (4) outcome (death, conversion to laparotomy, laparoscopic repair, spontaneous resolution).


RESULTS
Thirty-eight selected articles included 696,502 laparoscopies, with 1,575 injuries (0.23%), 126 (8%) of which involved blood vessels or hollow viscera (0.018% of all laparoscopies). Of the 98 vascular injuries, 8 (8.1%) were injuries to major retroperitoneal vessels. There were 34 other reported retroperitoneal injuries, but the authors were not specific as to which vessel was injured. Of the 28 injuries to hollow viscera, 17 were considered major injuries, i.e., 60.7% (0.0024% of the total cases assessed).


CONCLUSIONS
The insertion of the Veress needle in the abdominal midline, at the umbilicus, poses serious risk to the life of patients. Therefore, further studies should be conducted to investigate alternative sites for Veress needle insertion.
Azevedo
João Luiz Moreira Coutinho
JL
Department of Surgery, Division of Operative Techniques and Experimental Surgery, Federal University of Sao Paulo, São Paulo, Brazil. jozevedo.dcir@epm.br
Azevedo
Otavio Cansanção
OC
Miyahira
Susana Abe
SA
Miguel
Gustavo Peixoto Soares
GP
Becker
Otávio Monteiro
OM
Hypólito
Octávio Henrique Mendes
OH
Machado
Afonso Cesar Cabral Guedes
AC
Cardia
Wellington
W
Yamaguchi
Gilmara Aguiar
GA
Godinho
Lola
L
Freire
Dalmer
D
Almeida
Carlos Eduardo Saldanha
CE
Moreira
Camila Hobi
CH
Freire
Dalmer Faria
DF
D001808:Blood Vessels / Q000293:injuries*; D004618:Embolism, Air / Q000209:etiology; D004867:Equipment Design; D005260:Female; D005313:Fetal Death / Q000209:etiology; D041981:Gastrointestinal Tract / Q000293:injuries*; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality; D006801:Humans; D007327:Insufflation / Q000295:instrumentation; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D010535:Laparoscopy; D007813:Laparotomy; D009339:Needles / Q000009:adverse effects*; D010538:Peritonitis / Q000209:etiology; D011028:Pneumoperitoneum, Artificial / Q000295:instrumentation*; D011247:Pregnancy; D015995:Prevalence; D011677:Punctures / Q000009:adverse effects*; D001743:Urinary Bladder / Q000293:injuries