title: Veress needle insertion into the left hypochondrium for creation of pneumoperitoneum: diagnostic value of tests to determine the position of the needle in unselected patients.
abstract: OBJECTIVE
  To assess the effectiveness of the Veress needle puncture in the left hypochondrium and the accuracy of the tests described for the intraperitoneal correct positioning of the tip of the Veress needle in an unselected population.
  
  
  METHODS
  Ninetyone patients consecutively scheduled for Videolaparoscopy had the abdominal wall punctured in the left hypochondrium. There were no exclusion criteria. The patients received general anesthesia and mechanical ventilation according to the protocol. After puncturing five tests were used to confirm the positioning of the needle tip within the peritoneal cavity: aspiration test--AT; resistance to infusion--Pres; recovery of the infused fluid--Prec, dripping test--DT, and test of initial intraperitoneal pressure--IIPP. The test results were compared with results from literature for groups with defined exclusion criteria. The results were used for calculating sensitivity (S) specificity (E), positive predictive value (PPV) and negative predictive value (NPV). Inferential statistical methods were used to analyze the findings.
  
  
  RESULTS
  There were 13 failures. AT had E = 100% and NPV 100%. Pres had S = 100%, E = 0; PPV = 85.71%; NPV does not apply. Prec: S = 100%, E = 53.84%, PPV = 92.85%, NPV = 100%. DT: S = 100%, E = 61.53%, PPV = 93.97% NPV 100%. In IIPP, S, E, PPV and NPV were 100%.
  
  
  CONCLUSIONS
  The puncture in the left hypochondrium is effective and the performed tests guide the surgeon regardless of sex, BMI, or previous laparotomy.
authors.affiliation: Department of Surgery, Federal University of São Paulo and at the Surgical Gastroenterology Service of Hospital Municipal José de Carvalho Florence, Sao Jose dos Campos, Sao Paulo-BR.
authors.forename: Otávio Monteiro
authors.initials: OM
authors.lastname: Becker
authors.forename: João Luiz Moreira Coutinho
authors.initials: JL
authors.lastname: Azevedo
authors.forename: Otávio Cansanção
authors.initials: OC
authors.lastname: de Azevedo
authors.forename: Octávio Henrique Mendes
authors.initials: OH
authors.lastname: Hypólito
authors.forename: Susana Abe
authors.initials: SA
authors.lastname: Miyahira
authors.forename: Gustavo Peixoto Soares
authors.initials: GP
authors.lastname: Miguel
authors.forename: Afonso Cesar Cabral Guedes
authors.initials: AC
authors.lastname: Machado
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009339:Needles; D011028:Pneumoperitoneum, Artificial / Q000295:instrumentation* / Q000379:methods; D011237:Predictive Value of Tests; D055815:Young Adult