title: Injuries caused by Veress needle insertion for creation of pneumoperitoneum: a systematic literature review.
abstract: 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.
authors.affiliation: Department of Surgery, Division of Operative Techniques and Experimental Surgery, Federal University of Sao Paulo, São Paulo, Brazil. jozevedo.dcir@epm.br
authors.forename: João Luiz Moreira Coutinho
authors.initials: JL
authors.lastname: Azevedo
authors.forename: Otavio Cansanção
authors.initials: OC
authors.lastname: Azevedo
authors.forename: Susana Abe
authors.initials: SA
authors.lastname: Miyahira
authors.forename: Gustavo Peixoto Soares
authors.initials: GP
authors.lastname: Miguel
authors.forename: Otávio Monteiro
authors.initials: OM
authors.lastname: Becker
authors.forename: Octávio Henrique Mendes
authors.initials: OH
authors.lastname: Hypólito
authors.forename: Afonso Cesar Cabral Guedes
authors.initials: AC
authors.lastname: Machado
authors.forename: Wellington
authors.initials: W
authors.lastname: Cardia
authors.forename: Gilmara Aguiar
authors.initials: GA
authors.lastname: Yamaguchi
authors.forename: Lola
authors.initials: L
authors.lastname: Godinho
authors.forename: Dalmer
authors.initials: D
authors.lastname: Freire
authors.forename: Carlos Eduardo Saldanha
authors.initials: CE
authors.lastname: Almeida
authors.forename: Camila Hobi
authors.initials: CH
authors.lastname: Moreira
authors.forename: Dalmer Faria
authors.initials: DF
authors.lastname: Freire
mesh_terms: 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