The pressure profile test is more sensitive and specific than Palmer's test in predicting correct placement of the Veress needle.
OBJECTIVE
Although the majority of laparoscopic complications result from improper Veress needle placement, the safety tests commonly used to determine correct placement are not always reliable. A prospective observational study (Canadian Task Force Classification II-2) was set up to determine the reliability of Palmer's and pressure profile tests in predicting the correct intraperitoneal placement of the Veress needle prior to insufflation.


METHODS
One hundred consecutive women undergoing gynaecological laparoscopic surgery between September 2006 and June 2007 were recruited. The operating surgeons conducted Palmer's and pressure profile tests in all 100 cases and recorded the ease with which these tests were performed and whether or not they felt that the needle placement was correct. They were also asked to comment on the saline drop test and double click acoustic test if appropriate.


RESULTS
The overall sensitivity of Palmer's test was 0.92 while its specificity was 0.5. The overall sensitivity and specificity of the pressure profile test were 0.99 and 0.75, respectively, making this a more reliable test for predicting intraperitoneal placement of the Veress needle.


CONCLUSIONS
The pressure profile test was a more reliable guide to confirming the correct placement of the Veress needle as a negative test is more likely to indicate failure to achieve intraperitoneal placement.
Yoong
Wai
W
Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London N18 1QX, UK. wai.yoong@nmh.nhs.uk
Saxena
Shika
S
Mittal
Monica
M
Stavroulis
Andreas
A
Ogbodo
Elisha
E
Damodaram
Mellisa
M
D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007327:Insufflation / Q000009:adverse effects; D010535:Laparoscopy / Q000379:methods*; D009339:Needles; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects / Q000379:methods*; D011237:Predictive Value of Tests; D011312:Pressure; D011446:Prospective Studies; D012680:Sensitivity and Specificity